2021-11-12 Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meeting

Call Structure & Name Changes

• Friday 12noon ET - Payer Data Exchange (PDex/Formulary/PlanNet) Implementer Support Meetings
• Friday 2pm ET - Payer Data Exchange (PDex/Formulary/PlanNet) Version 2 Meetings (formerly the PCDE call)

Save the Date: The final 2021 Community Roundtable will be held Wednesday Dec 8th at 4 pm ET. This replaces both the Nov & Dec roundtables. See Da Vinci 2021 Calendar

HL7 FHIR Connectathon (CST)   

January 10-12, 2022   •   Virtual Event

Register here: https://www.hl7.org/events/fhir/connectathon/2022/01/

Early Bird Registration through Saturday, December 04, 2021.  Online registration closes December 13. 

Confluence Event page:  2022 - 01 Connectathon 29 

• 2022-01 Da Vinci Payer Data Exchange (PDex STU2, Payer-to-Payer, Patient Access API)

• 2022-01 Da Vinci Payer Data Exchange Formulary and Plan-Net

Da Vinci summary coming soon- HL7 Virtual Connectathon - January 2022

Leads to share anything noteworthy from Zulip Discussions.

Open for Questions. 

Plan Net Discussion

• review phase 2 tickets that amounted to IG changes. 
• Team is thinking about the need for Ballot vs. STU Update (v1.1.0)  based on these changes and will work with FM to determine best next steps. 
• Share summary of proposed solution with active and period to address  

  FHIR-33206 - Ability to manage Provider Directory List for incoming/outgoing providers

Share Assessment of updating Plan Net IG to point to USCore 4.0

• Point to US Core 4.0 and Test, confirm it builds. 
• Notes from Core team meeting included:
  • Changes to Practioner – backwards compatible changes – check what changes we made, we are using USCore now.
  • Changes to PractionerRole – not using USCore today. We had to use our own profile since to relax the cardinally and must support.  Verify that those updates were made to USCore 4.0 and therefore we can now point to it. Yes we can!
    • FHIR-34288 - Going to change the Practitioner Role to the USCore, with the update to USCore 4.0 the constraints now align so we can point to it directly.   
  • Note: Formulary is using the product value set from Plan Net on Insurance Plan Type 

Quick Review of all the Tickets in the attachment today:

FHIR-34289 - updating the diagram. 

FHIR-31570 - Addresses change to be consistent across all the address fields, 0..*

FHIR-33206 - Ability to manage Provider Directory List for incoming/outgoing providers

• • Use of Active and it's meaning (record status not business status of active in the network.)
  • Comments of the PractionerRole.active
• Option for calculated field for active status to be based on period?
• Not a lot of changes, other than Period... which we'd change to MUST support. Should it be required? 
  • The way the period works now is you don't have to have a start or end date.
  • We have providers that will not be come active until 2 months from now.  This is where period is essential. 
  • For all the records that are just active with no data to the period, this is burdensome to require.  They'd like use 1900-01-01 as a start date. 
• Need to give guidance and additional guidance so that they can retain records so they can pre-load a start date and also set an end date in advance. 
  • Think about adding language: "Changes to maintain provider status in network also helps to address the Consolidated Appropriations Act."   

Can these changes be included in an STU Update process vs. a full Ballot... do we think the community will have concern about the changes we've made? 

Does it matter how many implementations there are? No hard and fast rule, just more people that may have an opinion. 

Either way, we are not forcing anyone to go to a 1.1.0 version vs. a 2.0.0 version (Ballot on the changes.)  

No strong opinions either way. 

• Movement of the data.

• Not about Patient right of access. (for Payer to Payer)
• For payer to payer - this is operations (under HIPAA TPO) between covered entities - so as a Payer s not required to get consent. So.... why are we sharing Consent?
• Two reasons:
  • Declaration for the new payer that indeed the patient has consented. 
  • the payer to payer exchange does not change was is additionally protected data.  (e.g.s HIV Status, minors in NJ, 42CFR)
• Consent part is the exchange. 
• Authorization for the additionally protected data.

Reminder to Bob on: Draft and submit questions to CMS about the Authorized Representative for consent on Payer-to-Payer data exchange. 

Next Week

No call day after Thanksgiving. 

PDex IG Companion Guide List

PDex IG Companion Guide - Laboratory Reporting Resources

Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0818 v2.xlsx

DRAFT - PDEX US Core Mapping from CPCDS source: ResourceMappingUSCoreCPCDS-2020-05-29-v26.xlsx

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