2023-04-14 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Review ANSI Anti-Trust Policy

Planning Da Vinci IG Implementation Testing?

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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.

CARIN-BB-EOB-Non-FinancialProfileSupport.pptx

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

No new tickets entered recently.

Bob provided some information/guidance to Mark to help address the last remaining tickets. 

There are two tickets related to NUCC Updates - related to the taxonomy.

FHIR-36472 - Getting issue details... STATUS

FHIR-36473 - Getting issue details... STATUS

• BD: Are we binding to a specific release?
• RG: Binding to specific codes in the value set, not release. 
• BD: Is there a reason we did that? I thought we used the entire provider taxonomy. 
• RG: Could do that in the future but question whether this is really what we want to do. Consider filing another ticket to review and see if we can bind to the entire code system and review with others. 
• BD: What's our process for applying to the IG?
• RG: These would be applied in next release of the IG (STU update, etc.). 
• BD: Would assume vocabulary updates could be an STU update. Would think we would want to do that rather than waiting for a new version of the IG. 
• SR: There are some taxonomy codes identified in our system that are not in our system. 
• RG: Right now, the process is to add codes as they are identified. If you want to submit a ticket to add all NUCC codes, that can be done. We can approve the ticket(s), but have not determined when we will bring back an STU update. Not currently scheduled but probably need to discuss in the near future. 
• DV: Wonder if there was an intent that we only wanted NUCC codes down to a certain level of granularity. 
• BD: Don't remember but there must have been a reason we didn't include them all. Will have to research further. 
• CS: Seem to recall that some  codes didn't apply because some are individual versus organization and no hierarchy to clarify. 
• No concerns with adding the new codes suggested in the above tickets. 
• Tickets marked ready for vote

FHIR-33138 - Getting issue details... STATUS

• The last statement in the ticket is not correct. US Core does support 410 deleted resource. But US Core does not require support for delete operation. If you don't support a FHIR delete, you don't have to support 410. You just get a 404. 
• MS: Is this allowing someone to see that something has been removed and may want to remove their own records. Otherwise, how do you determine what's no longer there. 
• BD: If you ask for all updates at a point in time, doesn't' help you determine what's been deleted. 
• RG: New R5 does give indication that something has been deleted. 
• BD: Does bulk?
• RG: Not sure.
• MS: But PlanNet doesn't support bulk, does it? It's something discussed but hasn't been added. 
• CS: Not addressing bulk in PlanNet - no guidance. 
• BD: Talked about it as part of next update - we should add a ticket. 
• Flagged as not persuasive. 
• Rick added comment for those who requested in-person to review. 
• Ticket marked ready for vote. 

FHIR-34875 - Getting issue details... STATUS

• RG: Suggested we mark this as consider for future use. In FHIR R5, expanded context of use to other resource. 
• Context of use is restricted to Patient.communication. This has been fixed in R5. Will consider this when we move to R5. 
• Ticket marked ready for vote.

FHIR-34439 - Getting issue details... STATUS

• CS: Provider roles versus taxonomies at the time was a mess. But scope of codes changed with each version. Think US Core 3.1.1 was wrong.
• BD: Need to confirm what payers have to use. 
• MS: Ended up with different practitioner.role. 
• Made profiles match as closely as we code. Only that varied were based on feedback from payers. 
• what's in US Core 5 and 6, expands what is in 3.1.1.
• CS: Codes are different. Is this a VSAC value set? Yes. 3.1.1 had value sets defined within the spec for specialty and the role. Specialty moved into VSAC. 
• As long as we are dependent on 3.1.1, there is nothing we can do. Flagged for future use and indicated that next time we update, will consider this. 
• BD: Not sure the value set is one we should adopt. 
• RG: Just saying we would revisit it at a later time. 
• Ticket marked ready for vote. 

FHIR-37415 - Getting issue details... STATUS

• The commenter appears to be looking for a custom value set to define type.
• RG: No reason that they cannot create their own extension. 
• BD: They can do it but not sure they can communicate, well given the standard. We should reach out to Kate and invite her to a National Directory call since it impacts that standard as well. Then bring the results back to this group for Plan Net. 
• Will revisit during a future discussion.

FHIR-37556 - Getting issue details... STATUS

• Commenter indicates the Plannet profile of PractitionerRole re-uses the value-set binding for qualification as found on the Practitioner resource profile. That value set includes the NUCC provider taxonomy as part of its values. 
• BD: This was intentional - practitioner.role is an extension because there was none. Did it purposely to make it the same so you could specify qualification as part of the role. The intent was to allow roles that had qualifications that were role specific. 
• Ticket marked not persuasive and ready for vote.

Adjourned at 1:59 pm ET

Source code is here: https://github.com/HL7/davinci-epdx

Payer-Payer Trust outline: Payer-Payer Trust V3.docx

Alex Kontur

Nathaniel Hosenpud 

Amol Vyas 

Nick Radov 

Artem Sopin 

Ben McMeen 

Jeff Brown 

Bob Robert Dieterle

Jeff Helman 

Brett Atwood 

Rick Lisseveld 

Ronald Wampler 

Karen Barbeau 

Ryan Howells 

Casey Trauer 

Ryan Moehrke 

Charlie Provenzano

Sanket Raval 

Chris Johnson 

Scott M. Robertson 

Christol Green 

Sean Mahoney 

Christopher Gracon

Kevin Prince 

Shanna Hartman 

Corey Spears

Sheljina Ibrahim 

Lloyd McKenzie

Mark Neumuth 

Stephan Roorda 

Mark Roberts 

Mark Scrimshire

Susan Langford

Daniel Lilavois 

Daniel Venton 

Michael Cabral 

Tom Loomis 

Diederik Muylwyk 

Michael Gould 

Doug Williams

Wendy Gereke 

Erin Huston 

Ming Dunajick 

Ezequiel Morales 

Igor Sirkovich