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FHIR Layer EXchange (FLEX) Release Notes

Tooele County Optum Behavioral Health

May 20, 2022 - Release 2.4.0

Access Management

Third-party Vendor Portal

Added new Optum Branding 

Patient Access APIs

Claims APIs

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®):

http://hl7.org/fhir/us/carin-bb/history.html  

1.       Updated “id” data type from “string” to “token” for the following resources: 

Conformance

Resource

Parameter

Type

Example

SHALL

ExplanationOfBenefit

_id

token

GET

[base]/ExplanationOfBenefit?_id=[id]

SHALL

Coverage

_id

token

GET [base]/Coverage?_id=[id]

SHALL

Patient

_id

token

GET [base]/Patient?_id=[id]

2.       Added the ability to perform search operation by multiple comma-separated “_id”s. Example: GET [base]/Coverage?_id=[id1],[id2],[id3] 

Public Directory APIs

Provider Directory APIs

DaVinci PDEX Plan Net: http://hl7.org/fhir/us/davinci-pdex-plan-net/history.html

1.       Added the ability to perform search operation by “_revinclude” for the following supported attributes, which allows the search response to include resources that have a relationship to the primary resource(s) in the search request:  

 

Resource

Supported _revinclude attributes

Organization

HealthcareService:organization

OrganizationAffiliation:primary-organization

PractitionerRole:organization

 

PractitionerRole:network

OrganizationAffiliation:participating-organization

Practitioner

PractitionerRole:practitioner

 

2.       Added the ability to perform search operation by multiple comma-separated “_id”s. Example: GET [base]/Practitioner?_id=[id1],[id2],[id3]

Payer to Payer (future functionality)

In 2021, the Centers for Medicare and Medicaid Services (CMS) opened the door for health plan members to easily access and share their health data. Members can securely and seamlessly transfer their health information from a prior health plan to their new health plan (Payer). Members must grant Payers permission to access their previous health plan information. 

Functionality to support this member-initiated Payer to Payer data exchange has been implemented for Data Acquisition and Data Externalization workflows. However, full functionality in production is dependent on forthcoming CMS updated rulemaking and other Payers supporting Payer to Payer registrations.

Data Acquisition: 

A current member of Optum Tooele requests their health data be obtained from their previous or another current Payer (e.g., Aetna, Medicare)

Data Externalization: 

A member with a different Payer (e.g., Aetna, Medicare) requests Optum Tooele send their health data to their new Payer. The member must be a current or past member of Optum Tooele to initiate this request. Data Externalization is only allowed within 5 years of leaving the covered health plan

Known Issues

[DE571635] Personal Representative is not able to select the member they are working on behalf of