2023-03-24 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 

Upcoming Conference Call Adjustments

• March 31st: Shortened call - start at 1:30 PM ET
• April 7th: Shortened call -  start at 1:30 PM ET
• April 14th: Normal call - start at 1:00 pm ET; Plan Net discussion second half of the call
• April 21st: Cancelled due to HIMSS
• April 28th: Normal call - start at 1:00 pm ET; Connectathon Kick-off
• May 5th: Cancelled due to Connectathon travel
• May 12th: Cancelled due to WGM

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

• • April 14th 

Please make note of changes to the meeting schedule in the upcoming weeks. These updates will be reflected in the HL7 Conference Center. Be sure to update your local calendars! 

Crystal to see if we can shift this call to occur from 1:30 - 2:30 pm ET on a regular basis after the May WGM. 

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 (comment period extended to 4/22/23)
• 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
• PDex Track Kick-off on April 28th at 1:00 pm ET

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. WGM+ Agenda now available! 

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.

Next meeting on March 30th at 2 pm ET. Dial in: https://leavittpartners.zoom.us/j/99147637652?pwd=RHlIa2p2dVc1MjhER2F5TldsTGo2dz09

Check out the discussion on Zulip. Zulip Channel: https://chat.fhir.org/#narrow/stream/204607-CARIN-Blue.20Button.20IG

CARIN has done good work building out profiles to support claims data. PDex deals with mechanism for payers to access the data. Trying to find a path for payers that avoids extra work (e.g., creating new profiles and doubling data that needs to be published). Would like to avoid a complex processing component. Worth paying attention to this discussion. 

Lloyd offered a couple options. Follow up discussion will occur on March 30th to discuss these options.

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