Mark Scrimshire <mark.scrimshire@onyxhealth.io>; Co-lead : Ezequiel (EZ) Morales <ezequiel.morales@evernorth.com>
Short Description | Payer Data Exchange (PDex) is preparing an update to the STU2 version of the IG. This will incorporate changes to support anticipated regulatory changes related to Burden Reduction and Payer-Provider Bulk Exchange. This track will be testing out the changes to the IG made for the post STU2 Ballot Submission planned for 2023. PDex Formulary Break-out - Implementer support Office Hours | ||||||||||||||||||
Long Description | Testing of changes to the Payer Data Exchange IG that are planned for the post-STU2 version of the guide. With the recent NPRM that addressed Payer-to-Payer Exchange and Payer-Provider Exchange this will be an opportunity for payers to test their exchange solutions with other payers. PDex Formulary Break-out - Implementer support Office Hours | ||||||||||||||||||
Type | Test an Implementation Guide | ||||||||||||||||||
Related Tracks? | Member Attribution - for Payer-Provider exchange, CARIN-BB Patient Access API, FAST National Directory | ||||||||||||||||||
Call for participants | Payers, Vendors and Providers | ||||||||||||||||||
Track Prerequisites | Participate in Connectathon Preparation Sessions: 2023-01 Da Vinci Payer Data Exchange (PDex) and Formulary Connectathon Preparation Page PDex IG - Payer to Payer Exchange Review the following Page in the Continuous Integration Build: Payer-to-Payer Exchange Read up about mTLS. It is used to setup access to Dynamic Client Registration in OAuth2.0. Here is an article that may help (You can search for mTLS in a search engine for other explanations): https://codeburst.io/mutual-tls-authentication-mtls-de-mystified-11fa2a52e9cf Check out the mTLS Discovery repository: https://github.com/hl7-davinci/pdex-payer-payer FHIR Client Come prepared to interact with a FHIR Server. This can be accomplished with an application that can be configured or coded to make FHIR RESTful calls. See the "Step by step tutorial and sample projects" under the Helpful Links below for an example of how to do this use Postman. FHIR Server Come prepared for other FHIR Clients to be able to interact with your FHIR Server. Join Friday 1pm ET PDex Work Group Implementer Support Call and Connectathon Track Preparation meeting. These pre-meetings will be used to identify testing partners and to advance the testing scenarios. Here are some links to assist implementers: | ||||||||||||||||||
Track Lead(s) | Mark Scrimshire <mark.scrimshire@onyxhealth.io>; Co-lead : Ezequiel (EZ) Morales <ezequiel.morales@evernorth.com> | ||||||||||||||||||
Track Lead Email(s) | mark.scrimshire@onyxhealth.io, ezequiel.morales@evernorth.com | ||||||||||||||||||
Specification(s) this track uses | PDex CI Build: https://build.fhir.org/ig/HL7/davinci-epdx/branches/connectathon33/index.html Formulary: http://hl7.org/fhir/us/davinci-drug-formulary/2022Jan/. Formulary CI Build: http://build.fhir.org/ig/HL7/davinci-pdex-formulary/ Provider-API (PDex will reference Da Vinci Attribution IG: https://build.fhir.org/ig/HL7/davinci-atr/ mTLS endpoint directory: https://github.com/hl7-davinci/pdex-payer-payer Note: the directory has only the example from the PDex IG loaded – please load compliant examples based the plan for the Git directory | ||||||||||||||||||
| Expected Participants | Reference Implementation: If your organization intends to bring technology to this connectathon, please add yourself to this list and comment on each component. If your artifacts are available publicly, please add a URL. Otherwise, participants will contact the organizational POC for this information. Participants:
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Zulip stream | PDex: https://chat.fhir.org/#narrow/stream/235286-Da-Vinci.20PDex | ||||||||||||||||||
Track Kick Off Call | Kick-off call took place on April 28th during the regular 1:00 PM ET PDex/Formulary Workgroup call | ||||||||||||||||||
| Zoom Link | https://hl7-org.zoom.us/j/92482555863?pwd=TWQzVENNeStqeEpVTHdicGM2cGdMQT09 Meeting ID: 924 8255 5863; Passcode: 818984 | ||||||||||||||||||
Specification Information | CMS 2022 – 07 Da Vinci Payer Data Exchange (PDex) & Drug Formulary mTLS endpoint directory: https://github.com/hl7-davinci/pdex-payer-payer Note: the directory has only the example from the PDex IG loaded – please load compliant examples based the plan for the Git directory | ||||||||||||||||||
System Roles | Payer-to-Payer Exchange: Payer acting as Server and Client Clinical Bulk Download: Provider acting as Client. Payer actings as Server. | ||||||||||||||||||
Testing Scenario: | Preparation Steps: Roles involved:
Time Required: 1-2 Hrs Steps involved: Use Case 1 - Payer-to-Payer System roles:
Payers will need to register an mTLS endpoint into a GitHub repository to enable mTLS endpoint discovery. Role 1 Name: Establish mTLS connection Scenarios: Payer1 will search for Payer2 in mTLS endpoint repository Payer1 will request connection with Payer2 Payer2 will lookup Payer1 in mTLS endpoint repository to confirm legitimate request Payer2 will reciprocate connection back to Payer1 to establish mTLS connectivity. Scenario Step 1 Name Action: Payer1 and Payer2 successfully connect via mTLS Precondition: Success Criteria:
Success Criteria: Payer1 reaches $member-match operation with valid client credentials issued by DCRP endpoint via mTLS connection. Bonus point: Successful $member-match operation TestScript(s): TBD Security and Privacy Considerations:
Use Case 2 - Payer Provider System roles:
Providers will need to be registered with Payer with appropriate User level credentials to access the required FHIR APIs and Operations Role 1 Name: Get Patient info for Current Patient Roster Scenarios:
Precondition: Success Criteria:
Bonus point:
TestScript(s): TBD Security and Privacy Considerations:
Use Case 3 - Prior Authorization Profile System Roles:
Third-Party App accesses Prior Authorization Profile and presents information for Patient/member benefit. Use Case 4 - Formulary Bulk Export System roles:
Role 1 Name: Server Server provides $export operation to enable one or more Formularies to be exported. Role 2 Name: Client Client makes $export request to download formulary.
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