2021-08-06 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)

When: 9/13-9/15

Registration is now available here

Early Bird registration August 16th and last day to register is August 30th. 

Are there strings in the names of these drugs that would show up in one of the RX norms

Semantic Drug Form

The packs get more complicated that could have different forms.  

Define who will be responsible to sharing alternatives. 

Rob feels strongly that server's job (not the searcher) should be resonsible for sharing the alternatives based on ingredient.  More detailed notes on this here:  2021-07-02 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Product vs. Plan.

Medicare Advantage is a product. then Plans are underneath. 

For Medicare and others, their is high and low deductible. These 5 codes are standard based on the exchange.  It was agreed that this would cover the basis.  They are not going to map anything to these since it's not the same for Medicare.  

• there is no platinum plan in Medicare. 
• Medicare FFS and Tiers that would not be mapped. 
• Plans list the Medicare FFS, CHIP, etc. 
• Medicare uses the term "plans"

Proposed Action: Add some language to the definition to make it explicit in the code system for what to use for the common Products and plans. 

Cost sharing issue or different products?

SV: is there a definition for these 3 Medicare tier plans. 

SV: none map to medicare

Action Item: Let's go back and get some additional info. Dave will frame the questions and see what response we get to inform next decision.  At least, let's clarify with language and an example for Medicare, we may want to make changes to IG as well.  

Discussion on the FAQ #14 - Second paragraph of A. 

• Only appropriate if it's a transmitter provenance?   
• No - not about Transmitter.
• If a lab received the data from a Payer. 
• The date is the date it was sent.
• If it's type Author - the date is when it was authored. 
• That was received by the payer from the original data source. 

Mark proposed clarification to address Dan's concern ,

PDex: $everything on Patient and Bulk

We've heard some confusion around using $everything on patient and using bulk and how the provenance needs come into this. 

We want to clarify what the $everything on Patient means.  

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

For questions, reach out to us on Zulip:

• PDex: https://chat.fhir.org/#narrow/stream/235286-Da-Vinci.20PDex/topic/Implementers
• Plan Net: https://chat.fhir.org/#narrow/stream/229922-Da.2BVinci.2BPDex.2BPlan-Net
• Formulary: https://chat.fhir.org/#narrow/stream/197730-Da-Vinci.20PDex.20Drug.20Formulary

Formulary - Searching by DrugName.docx

Recording of Formulary Tickets for STU 1.1.0 Overview