2023-05-26 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

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

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

Next PlanNet Discussion:

• Friday, June 9th at 1:30 PM ET (during this meeting)

Now Available! Da Vinci In Action Interactive - Implementations To Date

A tracker to share general implementation progress across Da Vinci and the community. All listings are voluntary. Two goals for this tool:

1. Develop a picture of the progress of early adopters by Da Vinci membership (for Da Vinci leadership); and 
2. Create clarity for FHIR community, those who are in active development, ready for partners, and want to share contacts with wider community.

Upcoming CMS HL7 FHIR Connectathon (Virtual Testing Event)

Join developers, programmers, technology experts, analysts, and CMS colleagues to learn about and test emerging Fast Healthcare Interoperability Resources (FHIR) Application Programming Interfaces (APIs) and supporting FHIR Implementation Guides (IGs) at the 2023 CMS and HL7 FHIR Connectathon.

• July 18 - 20, 2023 from 9:00 am - 5:00 PM ET
• Register by June 30, 2023
• CMS 2023 - 07 FHIR Connectathon 4

Let us know if you plan to test so we can coordinate scenarios and plan for the event. 

Implementation Questions

• Richard asked about how consent and auth will be enabled for payer to payer exchange. What's the current state? 
• STU2 version of PDex includes payer to payer exchange which is currently based on using mTLS to establish trusted connection between two payers. When a new plan connects to old plan, gives access to Oauth dynamic registration endpoint so they can request set of credentials that can be used by a service to query the old plan so they can do a member match. 
• Member match is for a single member query - contains information from a member card to provide to new plan. Also gathers consent from new plan to get data from old plan. 
• Trying to finish publishing STU2 so we can do an STU update to address additional requirements of the new proposed rule. 
• Member mediated exchange versus member directed exchange. How are they directing? As I'm enrolling in the new plan, I'm prompted by new plan asking if they want data from their old plan. Member says yes, go and get everything. The new plan captures and puts in member match operation and sends to old plan. The old plan sends back FHIR ID and member data.
• This question went to OCR and as long as old plan gets permission from the member, it settles the requirement. And that's why we are exchanging consent resource.

Follow up on Formulary Issue Ticket (second half of the call) - https://jira.hl7.org/browse/FHIR-40985

PDex Future Enhancements

• This future enhancements page is capturing requirements for future iterations of the PDex IG. 
• Most items are driven by new regulatory requirements. 
• Mark reviewed the items currently logged in the Confluence page. 
• Discussion about inclusion of formulary in payer to provider API; may need clarification from CMS. 
• Provider directory is public; formulary was initially in the proposed rule, but when they published the final rule, it required member authentication so it became part of the patient access API. CMS said a plan could make it public but not required to make it public. Certain assumptions made when referring to patient access API. 

12:03:41 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    Today's Agenda: https://confluence.hl7.org/pages/viewpage.action?pageId=171443416
12:07:21 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    CMS Virtual Connectathon Registration Page: https://www.eventbrite.com/e/centers-for-medicare-and-medicaid-services-and-hl7-fhir-connectathon-tickets-627386478847
12:41:06 From  Corey Spears (Lantana)  to  Everyone:
    The Formulary Question we are discussing: https://jira.hl7.org/browse/FHIR-40985
12:42:53 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    https://confluence.hl7.org/display/DVP/PDex+Future+Enhancements
12:58:39 From  Chris Johnson - BCBSAL  to  Everyone:
    Christmas present for all of us...

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

PDex Future Enhancements

IQVIA

Elevance

Malcolm McRoberts

Manish Agarwal

Tulsi