Chair: Mark Scrimshire
Scribe: Vanessa Candelora
Create Decision from template
This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."
Minutes Approved as Presented
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
Moved to Supporting section below!
|2021 CMS HL7® FHIR® Connectathon Overview of Track|
|New Da Vinci Use Case|
Patient Cost Transparency Use Case- Kick off public call June 25th, 2021
Fridays at 11AM Eastern- here for call details, confluence page here
Kick off call started this week. Use case will mainly covering the price transparency rules for hospital and CAA.
Join on Fridays. Use case will impact all providers/payers.
Use Case #1: Need to develop an Advanced Search feature that may require to perform search across profiles e.g. single search that involves search using parameters such as Provider’s Name, Specialty, Health Plan, Spoken Language, Zip code or City/State and Gender.
Issue/Challenge: I this case I could not figure out a single profile that can be used to perform this search. Similarly, we cannot perform search in multiple steps (searching the search result) as this will be too complex plus will not work with pagination provided via FHIR server.
Formulary Ticket updates
PDex Formulary JIRA Tracker Dashboard
Updates from last week. Was presented to pharmacy group and received approval.
- FHIR-31683Getting issue details... STATUS Can't query. To do this in FHIR server, is to look for code/list of code. Problem could be that the FHIR server may have several list of code and you only want to use the one for coverage. For STU2, may be looking for the insurance plan. The insurance plan has a type where you can add the list of code.
Insurance Plan profile in Plan Net has a list code, under Insurance Plan Type or Insurance Product Type which has an extension.
Solution- set it to DRUGPOL as fixed value and use their code set. NCQA is currently using this resource to identify pharmacy plans.
For Plan Net- did we determine that pharmacy was more of a health plan as it is not separate from the medical plan
Are implementers already using a list for pharmacy plans?
could we use this code system and set to DRUGPOL. http://terminology.hl7.org/ValueSet/v3-ActCoverageTypeCode
- FHIR-31684Getting issue details... STATUS can't query medication knowledge drug without plan ID.
Question- is this relevant for the shopping experience. Is there a requirement to search the medication knowledge drug without a plan ID?
No strong solution, defer to STU2 to further drill down
Next Steps for support of CMS-9123 Burden Reduction (pended rule) and future version of PDex guides.
Context: the NPRM identifies a requirement for payers to share the active and in process authorizations with members, providers and other payers.
We're looking to exchange claim response, figure out accumulators, and how to identify the clinical data specific to the authorization.
Let's talk about the elements from PCDE that are relevant to help meet this need.
Change to calls going forward - we will use the former PCDE 2pm ET call time to drive the work to support the next version (HL7's STU2) of PDex, Formulary and Plan Net. Will update to weekly as well. The PDex call at 12noon ET will remain as is for Implementer Support and updates to existing version.
Put a list of enhancement together to add between now and January 22 Ballot, include updates for formulary. Enhance shopping experience and make it searier for formulary to be implemented
Enhance Plan Net to include phone number and possibly looking at bulk data
Enhance of PDex to see if we can include PA information, have data available to member, to payer and to next payer when member moved.
Will using the current PCDE public call to start working sessions on the building the enhancements.
This call will be used to continue to build implementation IG and help answers questions on the STU1.
Next steps- have this ready by December to enter January ballot. Intent is to ballot new section only. Tentative date of publication for STU2 if able, end of April 22.
Review FAQ Proposed Responses
Review Formulary Tickets
Adjourned at 12:56pm EST.
|PDex Companion Guides|
|CARIN CPCDS to US Core Mapping|
Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0818 v2.xlsx
DRAFT - PDEX US Core Mapping from CPCDS source: ResourceMappingUSCoreCPCDS-2020-05-29-v26.xlsx
|PDex - US Core |
Source PowerPoint: PDEXandUSCoreRelationship.pptx
|Da Vinci is seeking answers to open questions and clarifications needed on the implementation and operational needs of the upcoming CMS Patient Directed API Rules.|
Find initial questions and corresponding answers shared from our colleagues at CMS here
Source code is here: https://github.com/HL7/davinci-epdx
Da Vinci Implementer Support Page
Implementers can take advantage of tools: See the Reference links on the Payer Data Exchange (PDex) page to access links for Reference Implementations, sandboxes, test scripts, and more!
Da Vinci PDex for Patient Access API Frequently Asked Questions (FAQs)
CMS Final Rule Questions and Answers log
ONC FAST National Healthcare Directory (including end points) solution page that includes links to everything (solution doc, Connectathon, HL7 workgroup, etc.): https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/National+Healthcare+Directory
- David Hill-Look in the coverage resource and Medication Knowledge to designate where you would include a Formulary ID.
- David Hill Create ticket for updating the definition column on the 7.26.1
- David Hill- add the second ticket referenced to the FAQ 0017 question.
- Mark Scrimshire- Add FAQ for $everything and provenance guidance - 6/11 convo today.
Corey Spears create ticket from the variation in names and what the proper names for display are
Corey Spears create ticket on expected returns with regards to allowance for both brand and non-brand search matches.
Attendees - 31
Intepro Solutions Rakesh Mathew Daniel Lilavois Patricia R Harbin Shalabh Gautam Kamaraj Kaliaperumal, Carefirst Bhanu Vemuri Narasimha Murthy Accenture Google Cloud Healthcare Maggie Mellon Courtney Bland
Present Name Affiliation CMS BCBST Deepthi Reddy Mettle Solutions Allscripts Eric Sullivan Inovalon MITRE India Duncan Optum Availity Susan Lestina AHA Bob Bowman CAQH Thomas Kessler CMS Patrick Edwards Briana Barnes Scope Info Tech Kishore Metla Mettle Solutions John Donnelly Lorraine Doo CMS Melanie Jones CMS Rim Cothren Yolanda Villanova CMS Manoj Kumar BCBSFL MITRE Srinivas Konchada Centene Corporation Sheryl Turney Anthem Helina Gebremariam Mike Novales BCBSIL Ric Light Humana Ann Gallagher Optum Chris Klesges Mitre Adam Gronsky Health Fidelity CaseNet Anthem CMS eClinicalWorks Healow Interfaceware Mark Rucci Spectramedix Anthem Cindy Monarch BCBSM Michael Kim Jim Catan Accenture BCBSA Jia Chen Robert Dieterle Jeff Eastman Ernestine Cooper Jason Teeple CIGNA Lloyd McKenzie Mary Winter Rachel E. Foerster Tom Grannan Azuba Tony Benson BCBS AL Independence BC Henry Archibong Inovalon HL7 Consultant Abdul Sattar Anirudh Choudhary Todd Biske ESI Darrell Woelk Doug Stoss Rick Lisseveld Aegis LakshminarayananSaravanan Laurie Burckhardt WPS Health Plan Kevin Lynch Inovalon Joseph Minieri MITRE Durwin Day BCBS IL Pamela West Ravi Thakkar Aetna UO Aetna Swati Nanda Aetna CVS Health Cyrus Kevin MITRE Fred Harmon Ready Computing Blue Cross NC Michael Ryan NCQA HealthSparq CVS/Aetna Dorothy Lee NCQA Khoa Nguyen Suma Addagadde BCBSNC Caitlyn Campi FL Blue Diane Bengtson Sean Mahoney MITRE Balaji Richard Lisseveld Shanna Hartman CMS Kevin Day Edifecs Sai Bagewadi Cognizant Kechia Scott Kerri Wing Krithika Kumar Accenture Don Zacharia Evernorth Pamela Maklari Cognizant @David Bradsher BenMedica @DJ Gallagher @Follis @Nidhi @Emily Lozada Bruce Schreiber
Patricia R Harbin
Google Cloud Healthcare
Chris Johnson Independent Health Scott M. Robertson David Clowers Anthony Omosule Accenture
Present Name Affiliation Nancy Spector AMA Bruce Wilkinson BenMedica Avality BCBSAL MCG ONC Surescripts NCPDP Anupam Thakur BCBSFL Jonathan Hutchins BCBST Anthem Sunitha Godavarthi Christopher Gracon Labcorp James Derrickson Intersystems Cognizant Neetha Joseph Cognizant Kaiser Permanente MITRE Rutika Express Scripts Brody Brodock Allscripts Michael Brody CME Online Theressa Baumann BCBS AL Mona Chandrapal eClinicalWorks Optum Aakash Deliwala eClinicalWorks Mayo Epic Shaheer Stanley Nachimson Anthony Smith UNC Health Howard Cohen Minaei Behnaz FDA BCBSA Shilesh Nair gdit NewWave MaxMD BC Idaho Edward Castagna Altarum Andrea Kent CoverMyMeds Carrie Denny Kim Pham Celine Lefebvre AMA Edifecs Josh Lamb UPMC Keya Shah Casenet Gevity MITRE Mrugen Mehta eClinicalWorks Revathi Jayakumuar Supriya Bapi Bhera Matt Dyer Vyne Sree Vijetha Vegi C-HIT BCBSA Rich Bloch Lumedic Cigna Paul Knapp Ron Urwongse CAQH Anand Raghavan HealthLX Ezequiel Morales Cigna Evernorth Frank McKinney Hanna ? Brett Rauschke Carolyn McKinney Clarissa Winchester BCBS AL JC HealthShare Exchange (HSX) River Wong Rob McClure MD Partners Ronald Wampler CVS Health Aetna Derrick Woolridge Beata Ferraiz Ed Donaldson Consultant with Humana Julie Burgoon Mark Neumuth Aetna Raj Sankuratri Aetna Dr. Cheryl D. Lohman Germantown, MD | Family Physician Barbara Valeno Eshaa Dhall eclinicalworks Angie Brandon Bryan Briegal ACP Beatrice Thompson CVS Health Hema Srinivasa Kristin Ashby Aetna Nag Sanivarapu Abhishek Pandey Shailesh Prabhu Travis Hendrix Dr. First Zakir Guler Jason VanderJagt edifecs Erika Wagner Shamil Nizamov Michael Robinson Christopher Marchand Chris Busch Nathaniel Hosenpud Christopher Roedocker SKYGEN Jeff Brown Evernorth Sid Nehal Amin Amit Cudykier C45214 Noah Lincoff Yukta Bellani Evernorth/Cigna Brian Schoonover Optum Tone Southerland OneRecord @Ram Optum @Callie Phillips Kat Sobel Phung Matthews Benji Graham
Scott M. Robertson