Chair: Mark Scrimshire

Scribe: Crystal Kallem 


 Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Management

Review ANSI Anti-Trust Policy


Announcements

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)

Join us next Friday to discuss any PlanNet issue tickets and questions. 


Planning Da Vinci IG Implementation Testing?

Learn More here: Open Testing Tools - Build and Validate with Touchstone

The Touchstone Support team and Da Vinci Test Script authors are available to answer questions and provide support with testing Da Vinci Test Scripts in Touchstone.  Please don't hesitate to reach out to Touchstone_Support@AEGIS.net.



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.

Kick-off for PDex Track is proposed to take place on June 16th from 1pm - 1:30pm ET during our weekly call.



Save the Date: HL7 Meetings, Phoenix, AZ

  • HL7 FHIR Connectathon, Sept 9-10, 2023
  • HL7 Working Group Meeting, Sept 11-15, 2023

Register before Friday, August 18th to take advantage of the early bird rate.


CMS Connectathon Planning


PDex IG Tickets

Latest CI Build - 2023-06-02: https://build.fhir.org/ig/HL7/davinci-epdx/PayerToPayerExchange.html

New Section to Payer-To-Payer Page: https://build.fhir.org/ig/HL7/davinci-epdx/PayerToPayerExchange.html#trust-framework

Unresolved:

T Key Summary Assignee Reporter P Status Resolution Created Updated Due
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  • Last week, Mark was having a challenge publishing the build because of dependency on NDH. Has since taken the NDH extensions/value sets/code systems needed for mTLS bundle and ported them into PDex for now.
  • The build is now published (updated this morning). 
  • Resources now consistently refer to HRex coverage profiles (Jeff's ticket now marked resolved)
  • Now includes a section on trust framework, which should address the remaining four tickets on this topic.

FHIR-41177 - Getting issue details... STATUS

  • Per the prior auth proposed rule, the publication of a prior auth profile needs to reflect it's progression through completion, including if something is denied. In the prior auth profile (based on claim/claim response information used in burden reduction PAS IG), there is a date in place which reflects the response creation date. 
  • Mark emailed Paul for guidance since he recommended use of the EOB in the first place. 
  • This question asked how to reflect submission date and determination date in the prior auth profile - Mark offered suggestions to Paul and contained in the ticket's comment.
  • There is a section in the IG for supporting info; can have multiple supporting info elements and there is the ability to put in timing (as a date); this could, in theory, be used to record a date on action for adjudication. There is also a category field marked as an example. It has a series of claim information category codes as an example. 
  • Mark will also send a link to Kuldeep to get his input.

After these tickets are finalized, we can take them through to block vote and then finalize the IG for publication. 


Provider API Discussion

  • Provider API discussed on Da Vinci Architecture call yesterday
  • Been looking at provider API requirements that would be incorporated into PDex
  • Current methodology for accomplishing the requirements have been put into the current build of PDex as draft; utilizes DV member attribution IG to manage group resource that would contain attributed members, and a specific operation to retrieve data for the members in a given group. We have documented how that would be done. Piece that is missing is how a provider gets the permissions to actually access and use the secure API. That becomes the problem when you try to scale. 
  • The proposed rule requires that payers make available a provider access API and also requires that an attribution list be maintained; members they are providing services for. This is reflecting of CMS' data at the point of care.
  • Open questions - how does provider get access to payer's attribution list that the payer maintains, so they can submit that group list as part of their bulk data request for information on the members they provide services for. How to tie list to individual provider - does it pertain to organization or individual provider. Also, how does the provider authenticate to payer to get that list. If institution, how do they authenticate and can they do so for all of their providers. 
  • At simplest level, it's an individual provider's list. 
  • Trying to understand what currently exists.
  • If you expect a provider to log into every payer's website, you are going to get pushback. Don't disagree at all. But isn't' that the way that data at the point of care works? When originally rolled out, thought it was at the organization level. Need to verify. Looking for alignment with data at the point of care so providers only have to do it once.
  • Suspect that in order for this to work and people actually use - there aren't going to be any login screens. Needs to be a way to connect to the payer automatically and collect that day's worth of people. 
  • This is all exploratory. 
  • Scalability part screams UDAP; member data exchange feels like a client credential based flow where we need some level of fine grained access after initial authentication. Most conversations in FAST and SMART groups, everyone punts on the fine grained access. It's time to bubble this up; should talk again with the FAST group. It's now the second use case where this has come up. 
  • It's extremely complex. No decisions have been made and not even sure if we are asking the right questions yet. 
  • There is no requirement for the date it was submitted. Requirement is for the date it is approved or denied. 
  • There may be capabilities in OAuth with regard to scoped access that may be applicable here. 
  • Do payers attribute their members to an organization or do they only attribute to an individual provider (unless a specific risk agreement)? Check with your organizations and report back. Could also reach out to the Blue Button team and see how they do that.
Implementer Support

Implementation Questions


None

Chat

12:02:25 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    Today's agenda: https://confluence.hl7.org/pages/viewpage.action?pageId=171445029
12:10:21 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    Latest CI Build: https://build.fhir.org/ig/HL7/davinci-epdx/PayerToPayerExchange.html
12:11:06 From  Crystal Kallem (POCP / Da Vinci PMO)  to  Everyone:
    https://jira.hl7.org/browse/FHIR-41177
12:46:03 From  Ron Wampler - CVS Health / Aetna  to  Everyone:
    We'll find out for Aetna
12:46:15 From  Robert Dieterle  (EnableCare)  to  Everyone:
    thank you

 Adjournment

Adjourned at 

Outline Reference

Supporting Document

PDex Companion Guides

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

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

Links to Published IGs

Other Links:

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

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

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:

Formulary STU 1.1.0 Overview

Formulary - Searching by DrugName.docx

Recording of Formulary Tickets for STU 1.1.0 Overview

PDex Future Enhancements

PDex Future Enhancements

Action items

  •  

Attendees =

PresentNameAffiliation
PresentNameAffiliation
PresentNameAffiliation
  •  
ONC
  •  
Jacki HemenwayUPMC
  •  

  •  
Cambia Health
  •  
Jamie Smith

IQVIA


  •  
Naveenkumar Mani Anthem
  •  
Andrea Preisler AHA
  •  
James DerricksonIntersystems
  •  
Nehal AminCVS Health
  •  
Anthony Omosule

  •  
Janice HsiehAetna
  •  
UnitedHealthcare
  •  
Edifecs
  •  
Jarrett Cox

  •  
Nitin SahasrabudheCVS/Aetna
  •  
Ancel Salunga








  •  
Balaji NarayananOnyx
  •  
Jaspreet Kaur

  •  
Parth GabhawalaAetna/CVS Health
  •  
Barbara Doyle

  •  
Jamie ParkerAEGIS
  •  
Peter Gunter VA
  •  
Evernorth
  •  
Lantana, FM Co-Chair
  •  
Prabal Basu 
  •  
EnableCare
  •  
AEGIS
  •  
Rachel E. FoersterRFA Ltd
  •  
Brandon Raab 

  •  
Jim Iverson

  •  
Raj SankuratriAetna








  •  
Ravi ThakkarAetna
  •  
Brandon StewartLantana
  •  
Joanna ChanLantana
  •  
Richard AmbercrombiePalmetto GBA
  •  


  •  
Joe Joseph Quinn SmileCDR
  •  
Rick Geimer Lantana
  •  
Bruce WilkinsonBenmedica
  •  
Joel HansenCVS/Aetna
  •  
AEGIS
  •  
Bryan Briegel IBM Watson Health




  •  
CVS/Aetna
  •  
Caleb SuggsUPMC
  •  
Kanchan Kavimandan

  •  
Rosaline Shaw Elevance Health
  •  
Carie Hammond Aegis
  •  
Evernorth
  •  
Leavitt Partners/ CARIN Alliance
  •  
Smile CDR
  •  
Karen Landin

  •  
AEGIS
  •  
HealthLX
  •  
Kassie MintesnotLantana
  •  
Aetna/CVS
  •  
BCBSAL
  •  
Kate Dech 

  •  
Kaiser Permanente
  •  

Elevance


  •  
Kelli FordahlEvernorth
  •  

  •  


  •  
BCBS SC
  •  
Serafina Versaggi 




  •  
Kyle Brew 

  •  
Shamil Nizamov SmileCDR
  •  
Clarissa WinchesterBCBSAL
  •  
LakshmiAetna
  •  
CMS
  •  
Lantana
  •  
Linda

  •  
Elevance Health
  •  
Court Collins

  •  
Dogwood
  •  
Shital Patil
  •  
Courtney BlandCVS/Aetna
  •  

Malcolm McRoberts



  •  
Sonja Ziegler Optum
  •  
Crystal Kallem POCP, Da Vinci PMO
  •  

Manish Agarwal



  •  
Spencer Utley Epic




  •  
Margaret CouttsEvernorth
  •  
Stanley Nachimson Nachimson Advisors
  •  
Damian SmithEvernorth
  •  
 Aetna
  •  
IBM




  •  
Leavitt Partners/ CARIN Alliance



  •  
Dan Cinnamon 

  •  
Onyx
  •  
Susan CromwellIBM




  •  
Matthew MosierOnyx
  •  
BCBST
  •  
Aetna/CVS Health
  •  
Michael J. Cox Onyx
  •  
Tanner FuchsCAHQ CORE
  •  
United
  •  
Peraton
  •  
Evernorth
  •  
SmileCDR
  •  
ZeOmega
  •  
Traci O'Brien
  •  
Divya Pahilwani

  •  
MicheleCareEvolution
  •  

Tulsi

Aetna
  •  
Donna Haid

  •  
Michelle BarryAvaility
  •  
Vency MenezesCNSI




  •  
Michelle Benz

  •  
VijayCVS Health
  •  

Doug Williams



  •  
Mike Evans

  •  
AEGIS
  •  




  •  
Lantana
  •  
Yukta BellaniEvernorth/Cigna
  •  
Evernorth/Cigna
  •  
@Muhammad Muddassar Ali

  •  
UdyAetna/CVS
  •  
Farheen Khalil





  •  
Richard RogersAvaility
  •  
Gregg JohnsonBCBS SC







  •