Submitting WG/Project/Implementer Group
- Financial Management
Justification and Objectives
- The Connectathon will excercise the Risk Based Contract Member Attribution List FHIR IG and validate the
- Specific APIs proposed
- Specific Operations proposed
- Specific Data Structures proposed for representing the Member Attribution List. (Data Structures include Resources, profiles, valuesets, extensions)
This track will use what version of FHIR.
- Release 4
Clinical input requested (if any)
- None at this time.
Proposed Track Lead
- Payer Organizations
- Cambia Health Solutions (Payer)
- Provider Organizations
- Need Confirmation: Multicare ? (Provider)
- Need Confirmation: Providence ? (Provider)
- Need Confirmation: OCHIN ? (Provider)
- EHR Vendors
- Need Confirmation: Epic ?
A webinar will be hosted on 11/20/2018 3pm ET as part of the Member Attribution Public Call to share further participation information about this track.
Producer Role (Server)
- System that will be responsible for creating the Member Attribution List
- Server has to support the following resources
- RelatedPerson (Optional)
- APIs that would be required
- Search/Read on Group resource
- Bulk Data API:
- Group/$export with the above resource types being extracted.
- Effort Required: Few months if starting from scratch.
Consumer Role (Client)
- System that will be responsible for consuming the Member Attribution List.
- APIs that would be required
- Ability to Search/Read on the Group resource
- Invoke Bulk API for Group/$export
- Consume the data that is received and at least analyze the data.
- Effort Required: Few weeks if starting from scratch
Scenario 1: Consumer (Provider Organization) discovers the applicable Group Resource in Producers (Payer Organization) system
Ability for a Provider organization to discover the Group Resource representing the Member Attribution List that is applicable to their specific organization.
For example, Multicare would like to know which Group Resource in Cambi'a System is applicable for their organization using their NPI or TIN information.
- Provider Organization knows its own NPI and TAX Identification number
GET <Server Base URL>/Group?identifier:oftype=http://terminology.hl7.org/CodeSystem/v2-0203|NPI|ExampleNPI&identifier:oftype=http://terminology.hl7.org/CodeSystem/v2-0203|TAX|ExampleTIN
- Receive Group Resource from the API call.
Scenario 2: Consumer (Provider Organization) Requests the Member Attribution List from the Producer (Payer Organization)
Ability for a Provider organization to request the full Member Attribution List that is applicable to their specific organization. Note: The request has to be accepted by the Payer and eventually a Member Attribution List would be made available. This is an asynchronous request following Bulk Data IG specifications.
For example, Multicare would like to request the Member Attribution List from Cambia for a specific contract.
- Provider Organization knows the specific Group Resource for the specific contract that represents the Member Attribution List.
- The Group Id of the specific Group Resource that is applicable and was retrieved as part of Scenario 1
GET or POST <Server Base URL>/Group/[Group id]/$export?_type=Patient,Practitioner,PractitionerRole,Organization,Location,Coverage,RelatedPerson
- Request is accepted by the Payer and a Content Location is received as part of the Response.
Scenario 3: Consumer polls the Content Location for Request Completion and Member Attribution List data location.
Ability for a Provider organization to poll the Content Location received as part of Scenario 2 to determine completion status of the Member Attribution List Request issued in Scenario 2 and once completed identify the location of the files that represent the Member Attribution List.
For example, Multicare would poll the content location received as part of the response in Scenario 2.
- Provider Organization has requested the Member Attribution List which was accepted by the Payer.
- Provider Organization has the URL for the Content Location where the request status can be polled.
GET <Content Location from Scenario 2 response>
- Completion Status indicated by 200 HTTP code and the Response Body containing the URLs for the files representing the Member Attribution List.
- There needs to be at least one URL for each of the resource types specified using the _type parameter in the Scenario 2. (
Scenario 4: Consumer retrieves the files representing the Member Attribution List
Ability for a Provider organization to retrieve each of the files that represent the Member Attribution List.
For example, Multicare retrieves each of the NDJSON files representing the Member Attribution List.
- Provider Organization has the URLs to retrieve the files representing the Member Attribution List from the response indicating that the export request was completed.
GET <File URL for each Resource identified in Scenario 3 completion response>
- Retrieve the NDJSON files for each of the following resources.
Indicate any test scripts that will be used to help verify system behavior
Security and Privacy Considerations
SMART on FHIR Backend Services Authorization is specified by the IG. However it is not required for Connectathon purposes this time around since this is the first time this IG is being tested.