2023-03-17 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Single meeting on Fridays from 1:00-2:00 PM ET (reduced to 1 hour)

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

NEW! PDex Directory/Plan Net discussions will occur during the 2nd meeting of each month (last half of this call). Upcoming discussions:

• • March 10th
  • April 14th 

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

• Federal Register (officially published 12/13/22)
• Fact Sheet
• Comment period closed 3/13/23
• Da Vinci Comment Response Posted: Da Vinci (under Industry Statements & Updates)

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
• Da Vinci Comment Response Posted: Da Vinci (under Industry Statements & Updates)

May Ballot Cycle 

• Take part in the formation of consensus groups for the HL7 May Ballot Cycle! 
• Da Vinci Risk Adjustment Implementation Guide is included
• To participate in voting, you must join the consensus group by March 30, 2023
• Commenting and voting will take place March 31 – May 1, 2023

Need help navigating? Review the HL7 Balloting Resources for Da Vinci Newcomers

Upcoming HL7 Meetings, New Orleans, Louisiana

HL7 FHIR Connectathon, May 6-7, 2023

• 2023 - 05 Connectathon 33
• 2023 - 05 Da Vinci Payer Data Exchange (PDex) and Formulary

HL7 Working Group Meeting, May 8-12, 2023

New WGM+: These sessions at the May Working Group Meeting will help augment the typical standards development work happening in HL7's Working Groups and broaden the audience of those who wish to participate. Our theme for the meeting is policy as a driver of interoperability.

Register here before Friday, April 7th to take advantage of the early bird rate.

A Discussion took place on Thursday March 16th at the CARIN Alliance meeting around an approach to present the required non-financial views of Claims and Encounters.

Zulip Channel: https://chat.fhir.org/#narrow/stream/204607-CARIN-Blue.20Button.20IG

Here’s the dial in. Meeting is at 2pm ET on the 16^th.

https://leavittpartners.zoom.us/j/99147637652?pwd=RHlIa2p2dVc1MjhER2F5TldsTGo2dz09

Next call is in 2 weeks (March 30th)

Check out the discussion on Zulip. 

Next call will take place on March 30th at 2pm ET. 

• A topic of discussion was how to address requirement that was in proposed prior auth rule to provide non-financial view of claims and encounter. 
• There has also been discussion in the Zulip channel.
• Number of payers on the call. If non-financial versions of claims are produced, how to avoid duplication of data and requiring payers to implement extra processing on FHIR servers. Need an efficient way to handle this requirement. The proposal that had been put forward, was to utilize a feature in FHIR to use summary view. Could implement a different API endpoint - present a summary view of existing claims created and present as non-financial view. The issue is that there is a total file in EOB in CARIN profile that has a cardinality minimum of 1 and mustsupport indicator, and it's part of the summary view. Is there a way to either override "is summary" setting from base profile or is there a mechanism to make a change to the base profile to no longer require the total to be a summary field. 
• LM: Summary is set in the resource design and is not changeable. You cannot change it in a profile.
• MS: Then the question is whether we can change the base profile so that it's not a summary field. 
• LM: Could submit as a proposal for R fix. It would be a substantive change so would have to justify.
• MS: This IG has been implemented widely, generating millions of records. People are looking for an efficient mechanism to support this requirement. 
• LM: With FHIR there is no such thing as a view of data other than what you are authorized to see. Context of use doesn't come into play at all. If you need different sets of data coming back that has stuff filtered out or inserted in, the only way to make that happen is through custom operation. 
• MS: The group will continue to look at options. Since this is a venue where payers are present, making sure that folks are aware of the discussions. 

12:03:53 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    Today's Agenda: https://confluence.hl7.org/pages/viewpage.action?pageId=161058299
12:06:30 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    WGM+ Agenda now available! https://hl7.my.site.com/LightningMemberPortal/s/lt-event?id=a1Y7V00000YrACtUAN#/PLUS-Agenda
12:07:05 From  Stanley Nachimson, Nachimson Advisors  to  Everyone:
    All public comments on proposed regulations can be viewed at www.regulations.gov
12:08:37 From  RachelFoerster (RFA Ltd)  to  Everyone:
    Thanks. What's the detailed search here?
12:09:54 From  Stanley Nachimson, Nachimson Advisors  to  Everyone:
    use the title of the rule or the number.

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