Chair: Mark Scrimshire
Scribe: Holli Murphy
Meeting Minutes from Discussion
Review ANSI Anti-Trust Policy
HM reviewed the anti-trust policy.
Single meeting on Fridays from 1:00-2:00 PM ET (reduced to 1 hour)
Upcoming Conference Call Adjustments
NEW! PDex Directory/Plan Net discussions will occur during the 2nd meeting of each month (last half of this call). Upcoming discussions:
Shortened call while waiting for input. Holding that call at 1:30 PM ET allows for those participating in FAST to join.
Plan Net questions will be addressed in the April 14th call.
Planning Da Vinci IG Implementation Testing?
Learn More here: Open Testing Tools - Build and Validate with Touchstone
CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P)
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)
|Added another month for comments.|
May Ballot Cycle
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
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 Saturday, April 15th to take advantage of the early bird rate.
|Earlybird registration has been extended to April 15th.|
|Non-Financial Claims & Encounters Requirement|
A follow-up Discussion took place on Thursday March 30th at the CARIN Alliance meeting around an approach to present the required non-financial views of Claims and Encounters.
Next meeting on April 13th 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
MS: There was a CARIN Alliance meeting yesterday. Under the prior auth proposed rule there is a requirement for a provider API capability to publish claims and encounter data without the financials. The Patient Access API has been pretty widely adopted because of the CMS Interoperability Rule. There are hundreds of millions of claim records that have been created because we now have close to 7 years of data that needs to be maintained for each member. If we don't design it correctly, there is risk of duplication of data in order to produce the data in a new profile. Or it could require a lot of complex processing in the orchestration layer to filter out the necessary data. The CARIN Alliance group has been working through some ideas and I wanted to relay the ideas back to you.
Explored using the summary view. It doesn't work due to the way the base resource is configured.
There is a base COB profile and the CARIN BB IG created an abstract EOB resource which has multiple profiles for institutional, professional, vision, dental. One option we are looking at is an additional set of profiles defined (currently called) EOB Non-Financial. That removes the amount and total fields that are used to publish an EOB. What we are proposing would effectively delete those fields from the profile and then there would be the existing profiles that have all of the data and both of these are derived from the abstract profile. The reason we can't just do a one on top of the other inheritance is that if we constrain down the non-financial profile to remove the amount and total fields then we can't unconstrain that in any profile that is derived from that. So we will effectively have to have two parallel sets of profiles. From an implementer's perspective, you could effectively have an API endpoint that would access the non-financial profiles and another endpoint that could be accessing the full profile. The team didn't want the amount fields to be optional because that could have led to less data being available to the member.
CS: We're trying not to make any changes that would break the existing profile.
MS: We want to test a Connectathon. Can we load the data effectively for an abstract profile and then pull off two different views?
BD: How does the API single endpoint decide what you have access to?
MS: That would be down to the resources or scopes or you could implement as two different access points. Want it to be enforceable from the server side, not relying on the client side being obedient.
CS: Practically speaking, how are implementers doing this? They have 3 APIs. How are they making them available?
MS: At the moment they haven't had to. There is only the member view. In the next revision, we need to address bulk FHIR for multiple patients.
BD: Conceptually we can constrain a scope on a token to only be the non-financial. Has anybody done it?
MS: You can do it using SMART on FHIR STU2 set of scopes. There is the ability to effectively define the equivalent of the search parameter so that you could constrain to a profile.
BD: You'll never get both profiles.
MS: No, that wouldn't make sense. You only get one or the other.
RA: What is the adoption for the SMART STU2 scopes look like so far?
MS: I don't have any visibility into that.
MS: Thinking about it more, if you used API endpoints as a method of control, you wouldn't need SMART on FHIR STU2 because on the base URL you could have your capability statement that could constrain to the profile. I believe you could have a non-financial access point and a full access point.
BD: Can we have an access token that constrains to a capability statement? I believe we can. In which case, don't bother with the profile, do it with the capability statement. If I constrain my token to a capability statement, I already constrained it to a profile.
CS: The capability statement is specific to an endpoint.
MS: You would still have the resources defined in your scopes that are available through that endpoint.
|PDex IG Tickets|
Four outstanding tickets. Waiting for input from FAST.
|Implementer Support||Implementation Questions|
Adjourned at 1:42 pm ET
|PDex Companion Guides|
|Da Vinci is seeking answers to open questions and clarifications needed on the implementation and operational needs of the upcoming CMS Patient Directed API Rules.|
Find initial questions and corresponding answers shared from our colleagues at CMS here
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!
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:
|Formulary STU 1.1.0 Overview|
IQVIA Bob Robert Dieterle Elevance Malcolm McRoberts Manish Agarwal Tulsi Doug Williams
Present Name Affiliation Present Name Affiliation Present Name Affiliation ONC Jacki Hemenway UPMC Cambia Health Jamie Smith Naveenkumar Mani Anthem Andrea Preisler AHA James Derrickson Intersystems Nehal Amin CVS Health Anthony Omosule Janice Hsieh Aetna UnitedHealthcare Edifecs Jarrett Cox Nitin Sahasrabudhe CVS/Aetna Balaji Narayanan Onyx Jaspreet Kaur Parth Gabhawala Aetna/CVS Health Barbara Doyle Peter Gunter VA Evernorth Lantana, FM Co-Chair Prabal Basu EnableCare AEGIS Rachel E. Foerster RFA Ltd Brandon Raab Jim Iverson Raj Sankuratri Aetna Brandon Stewart Lantana Joanna Chan Lantana Richard Ambercrombie Palmetto GBA Joe Joseph Quinn SmileCDR Rick Geimer Lantana Bruce Wilkinson Benmedica Joel Hanson CVS/Aetna AEGIS Bryan Briegel IBM Watson Health CVS/Aetna Caleb Suggs UPMC Kanchan Kavimandan Rosaline Shaw Elevance Health Carie Hammond Aegis Evernorth Leavitt Partners/ CARIN Alliance Smile CDR Karen Landin AEGIS HealthLX Kassie Mintesnot Lantana Aetna/CVS BCBSAL Kate Dech Kaiser Permanente Kelli Fordahl Evernorth BCBS SC Serafina Versaggi Kyle Brew Shamil Nizamov SmileCDR Clarissa Winchester BCBSAL Lakshmi Aetna CMS Lantana Elevance Health Court Collins Gevity Shital Patil Courtney Bland CVS/Aetna Sonja Ziegler Optum Crystal Kallem POCP, Da Vinci PMO Spencer Utley Epic Margaret Coutts Evernorth Stanley Nachimson Nachimson Advisors Damian Smith Evernorth Aetna IBM Leavitt Partners/ CARIN Alliance Dan Cinnamon Onyx Susan Cromwell IBM Matthew Mosier Onyx BCBST Aetna/CVS Health Michael J. Cox Onyx Tanner Fuchs CAHQ CORE United Peraton Evernorth SmileCDR ZeOmega Traci O'Brien Divya Pahilwani Michele CareEvolution Aetna Donna Haid Michelle Barry Availity Vency Menezes CNSI Michelle Benz Vijay CVS Health Mike Evans AEGIS Lantana Yukta Bellani Evernorth/Cigna Evernorth/Cigna @Muhammad Muddassar Ali Farheen Khalil Gregg Johnson BCBS SC
Bob Robert Dieterle