2023-01-06 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Single meeting on Fridays from 1:00-2:30 PM ET

Join Zoom Meeting https://hl7-org.zoom.us/j/92482555863?pwd=TWQzVENNeStqeEpVTHdicGM2cGdMQT09 

• Note: January 13th call will be cancelled since folks traveling to Connectathon

CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P)

• Federal Register (published 12/13/22)
• Fact Sheet
• Comment period closes 3/13/2023

Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard Proposed Rule (CMS-0053-P)

• Federal Register (published on 12/21/22)
• Comments due 3/21/23

January Ballot Cycle 

• Da Vinci Member Attribution List Implementation Guide is included
• Commenting and voting will take place through January 11, 2023 (deadline extended because of Jira instability)

Save the Date! January Work Group Meeting & Connectathon

• Connectathon: January 14-15, 2023 (2023 - 01 Connectathon 32)
  • PDex Track Page: 2023 - 01 Da Vinci Payer Data Exchange (PDex) and Formulary
  • Preparation Page: 2023-01 Da Vinci Payer Data Exchange (PDex) and Formulary Connectathon Preparation Page
  • Track kick-off call recording
• Work Group Meeting: January 16-20, 2023

• Location: Hilton Lake Las Vegas Resort and Spa, Henderson, NV

Over the holiday break I made some updates to the Payer-Payer Repository. The latest version is here:

https://github.com/onyxhealth/Payer-Payer

• The Bundles are now in a bundles folder.
• There are instructions to run a dockerized HAPI Server (hapi-docker/run_hapi.sh)
• There is a python utlility to load the bundles into the HAPI Server (bundle-import/main.py)
• There is a python utility to do a search by provider name and return a .pem certificate file and supporting information file (bundle-import/get_cert.py)

I am in the process of updating the CI Build to migrate the bundles to using the updated National Directory of Healthcare Providers (NDH) IG. I am still having a few challenges migrating the Endpoint profile.

I also added a Provider API page to the IG to provide links to the Da Vinci Member Attribution IG and the Davinci-data-export operation. https://build.fhir.org/ig/HL7/davinci-epdx/Provider-API.html

Update: 2023-01-06: Further updates have also been made to the PDex CI Build. The mTLS Bundles have been migrated to use the National Directory (NDH) IG Profiles. The Payer-Payer Repository was also updated to include the new bundle examples.

Mark Roberts from the CARIN Alliance will also be joining the call to discuss final Connectathon preparation details.

• Mark summarized updates made to the Payer-Payer Repository over the holidays
• Created a HAPI docker folder which contains a batch file and shell script to run a dockerized instance of HAPI
• Also created a bundles import folder with a couple python utilities. One of them will clone the repository and you can pass a parameter to say which repository to clone. It will take the bundles folder and import it to HAPI to provide local instance of HAPI with endpoint and organizational resources available to query.
• Also wrote a get_cert utility to pass in a payer name and it will search against HAPI server. If it finds a match for organization, it will look up the endpoint, grab the public certificate and convert to a pend file. You can define where you want the file to be. It also create the same file name with an additional txt extension with information about what the search is. 
• The original National Directory query IG is being replaced by the National Directory of Healthcare Providers & Services (NDH) Implementation Guide. Mark has updated PDex to utilize the National Directory profiles in the various bundles - included in latest CI Build as of January 6th. 
• BM: Has there been any movement on CAs and actual certs?
• MS: Haven't heard anything about that at the moment.
• BM: It was almost like he was trying to enter some sort of contractual agreement with people which was opaque. 
• MS: Don't know where we stand on that. Believe Bob will be at the Connectathon so can discuss where things are at. 
• Mark demonstrated the repository which has been forked. Within a bundle, you will get a public certificate (base 64 binary).  
• DV: Still unclear how I, as a server operator, when I receive public certificate on this create dynamic client request. How will I use this public certificate to get organization info from the repository of organization infos? Are we guaranteed that the subject name is going to be an exact match to the organization name in the bundle?
• MS: Good question - need to think through this. You will be able to download the repository so you have a list of all of the endpoints. 
• DV: Don't care where the list exists. Ultimately, I have a list of potentially hundreds of organizations. I receive a client certificate (public only) in that request. What is the linkage between public certificate and finding that the correlating organization in that repository/server? 
• MS: Haven't tried whether we can do a search on extension and whether you could match the certificate itself. If you took cert that you received and converted to base 64 binary, could you compare to the records in the endpoint resource? 
• DV: That's an awful long string. If you were to take the certificate you got, get serial number from it, then find the endpoint associated with that certificate serial number, then maybe that would work. 
• MS: Will probably need to look at what we can decode from the certificate to query against organizations and endpoints. Haven't tried this yet. 
• DV: Will also depend on who the vendor of your client certificate is. Some of them may allow you to specify special attributes and some will not. 
• JH: Does the mTLS language in emerging IG speak to how that lookup is to be done? 
• MS: No, not specifying the lookup. What we focused on what leveraging profiles defined in the National Directory so that when that drops into place, there is less reengineering to do. 
• JH: In this big picture, that includes National Directory, have to believe that there is some best practice. You are asking whether someone has or is willing to dive into what this may look like. 
• JH: Joe Lamy on the AEGIS team is very deep in this space. Will ping him to see if he has any insight. 
• MH: Maybe we could discuss on a future core team call to then bring back to the group. We will take Dan's question and see if we can start to identify some solutions that demonstrate how you do that match. 

• Mark walked through the PDex and Formulary Connectathon Preparation Page
• Four scenarios that we hope to test at Connectathon 
• Last Connectathon, successfully tested the Member Attribution IG to test where a provider can reach out to a payer and request the information for a member that they have a treatment relationship with (Da Vinci Data Export Operation). http://build.fhir.org/ig/HL7/davinci-epdx/Provider-API.html
• Mark will see if he can track down the collection for Postman in case they want to use at the Connectathon. 
• Still looking for further testing of Da Vinci Formulary Bulk Export. 

• SR: Is this where PDex Plan Net is discussed?
• MS: PlanNet is very closely aligned with National Directory, so that has gravitated to the National Directory calls at 11 am ET on Thursdays. There is stuff happening with National Directory at Connectathon. They are looking to tie in, if bringing server or client that is loaded in ConMan, they hope to pull data from ConMan to populate the National Directory. There would be a set of records in the RI version of National Directory that would enable folks to discover each other's endpoints. If you have a question around PlanNet, that's probably National Directory. The biggest thing was being able to record whether providers and organizations were active. Rather than a monthly snapshot of your provider directory, it would be more of an ongoing update so you can see if a provider is going to be in next year's network or had dropped out. 
• SR: This relates to attributes on the practitioner cultural competency. There is an old JIRA ticket that has not been addressed since 2020. I'll follow up with the National Directory group. 

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

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

Karen Barbeau

Diederik Muylwyk

IQVIA

Tulsi