Stream: Da Vinci PDex Drug Formulary
Topic: PlanID Extension
Jason Teeple (Aug 15 2020 at 11:33):
Hi @Saul Kravitz The PlanID extension states: Unique, 14-character, HIOS-generated Plan ID number. Isn't a HIOS Plan ID only for QHP plans? How should payers handle other lines of business for the PlanID extension (such as Medicare, CHIP, etc...)?
Saul Kravitz (Aug 16 2020 at 01:18):
@Mark Scrimshire @Robert Dieterle
Saul Kravitz (Aug 18 2020 at 14:17):
Are there natural plan IDs for these other lines of business?
Jason Teeple (Aug 18 2020 at 17:06):
For non-QHP plans, yes, just not a HIOS ID. The language in the extension causes confusion: https://build.fhir.org/ig/HL7/davinci-pdex-formulary/StructureDefinition-usdf-PlanID-extension.html
Saul Kravitz (Aug 18 2020 at 20:07):
What is your recommendation for how it should be described? I can create a Jira ticket for the next update, or if you want to track it, you can create it.
Obviously, copying some of the descriptions lock-stock-barrel from the QHP formulary wasn't such a great idea, sigh.
Jason Teeple (Aug 19 2020 at 10:52):
Is the intention to have a unique plan ID for government mandated plans or all plans (including commercial)?
If the latter, could do something simple like: Unique, Payor generated Plan ID number. (Plan IDs must be unique, even across different markets.)
If the former, could do something like: Unique, generated Plan ID number, such as HIOS ID for QHPs or Contract Number for Medicare Advantage Plans. (Plan IDs must be unique, even across different markets.)
Saul Kravitz (Aug 19 2020 at 22:26):
https://jira.hl7.org/browse/FHIR-28293
David Clowers (Dec 22 2020 at 22:20):
Confirming that I'm interpreting this thread correctly in that we are not obligated to use HIOS IDs for the plan ID. We're just waiting for an update to the IG to reflect this per the above Jira ticket. Is that a correct assessment?
David Clowers (Dec 22 2020 at 23:51):
@Saul Kravitz Forgot to tag you here.
Saul Kravitz (Dec 23 2020 at 01:30):
@David Clowers Yes. The issue raised by @Jason Teeple remains unresolved, and should be addressed in a future update of the IG. The recent technical correction was just that -- addressing some purely technical issues in IG publication that weren't caught prior to publication of the STU1.
Dale Brown (Feb 05 2021 at 18:06):
Is the intention for the PlanID to be something that the patient or a provider associated with a patient has access to (such as being printed on their insurance card) or is an internal identifier sufficient?
My guess would be that, in order to support the search use cases that have PlanID in them, it would either need to be something that is accessible or it would need to be abstracted underneath via the front-end UI (i.e. via a lookup, predefined plan drop-down list, or something similar).
Saul Kravitz (Feb 05 2021 at 18:45):
Hi @Dale Brown - I think there are two issues.
1) the definition of the PlanID. See https://jira.hl7.org/browse/FHIR-28293
2) how would a user/member select the appropriate PlanID. In particular, how would the PlanID be selected with the member has already authenticated.
Last updated: Apr 12 2022 at 19:14 UTC
