2021-07-16 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Call Structure & Name Changes

• Friday 12noon ET - Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meetings
• Friday 2pm ET - Payer Data Exchange (PDex/Formulary/PlanNet) Version 2 Meetings (formerly the PCDE call)

• 2021 CMS HL7® FHIR® Connectathon - July 20-22, 2021
  • Confluence page: CMS 2021 - 07 Connectathon 2
  • Complete the HL7 Pre Connectathon Survey to designate which track you want to participate in.
  • See Participant Information Session deck and recording from Thursday, July 8th at 4:00 PM ET.

• Connectathon Track pages. 

  • CMS2021-07 Patient Access API - Payer Data Exchange IG (including Formulary)
  • CMS2021-07 Payer to Payer Data Exchange - Payer Data Exchange IG
  • CMS2021-07 Provider Directory - Da Vinci Plan Net

CMS Connectathon CConMan: http://conman.clinfhir.com/connectathon.html?event=cms

Will check to see if we will have a call next week due to CMS connectathon. Add comments in chat if you prefer to have it or cancel it. (no comments)

Review FAQ Proposed Responses 

#23 Provenance

• Provenance can have multiple target. Rule for provenance is that it's one provenance for the event. Provide provenance for the bundle and for the other data sources. Bundle would have the transaction record. Can't necessarily apply reverse include operation to have provenance. May be ideal to test this out, at next connectathon. 
• If you use $everthing, you should get provenance, if not, may need to query each resource separately. 

#24 Payer to payer

• Payer app would expect to be synchronous with request. 
• guidance from CMS is to point to the API and ability to respond on the payer to payer exchange, in theory within one business day. Challenge is the connectation between payers to payers. 

#25 Payer to Payer

• Data retrieved from another payer is meant to form part of the member record in the Patient Access API. However no requirement for receiving payer to convert individual records to FHIR. 
• doesn't have to be FHIR but need to be integrated within the payer system to be part of members records. 
• rule state you keep the data in the format received. 
• If data is received over proprietary API, they should be set up to know how to read the file and use it. But if they are sent via a zip file, it may be useless as payers may not be able to use the data. 
• no requirement to received data from patient API and make it part of the patient access API but requirement is to be part of the patient record.
• required to be downstream via interoperability rule, received in the format sent and add it to member record
• If sending zip file without metadata, it would be just noise and useless to the member. No requirement that it gets pass on to the member. 
• heavy lift on payer to decide what clinical data should be exchanged via USCDI and already is in FHIR, so why send it via another form?
• option to send via another format is only available for 12 months as it then would require data via FHIR. 

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

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

Find initial questions and corresponding answers shared from our colleagues at CMS here

• Links to Published IGs

• PDex STU 1.0.0
• Plan Net STU 1.0.0
• Formulary - STU 1.0.1

Implementer Resources

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