Discussion per 10 July meeting of PS WG and related to uploaded file on API:

[laskeyk]

• Does PSV replace what we previously discussed as Integrity Check?

CAQH: Yes. Our proposal is to call it PSV because the API allows for individual verification of data elements. Calling it "Screening" or "Integrity Check" implies that all validations are performed every time. However, we are open to what the work group decides on this.

• Are we assuming PSV as defined is currently available as COTS/GOTS/OS?

CAQH: Yes. Most, if not all verifications are available in some COTS products.

-- followup: how does COTS API relate to the proposed API in slides?

• Is "Services to perform” the choices among the individual squares in the third slide?

CAQH: Yes. The Risk Category and Verification Type also plays a role in deciding what services to perform for that provider.

• Who is Risk Category evaluated by to be used as PSV input?

CAQH: The Risk Category is based on CMS guidelines for risk determination based on Provider Type. The provider type is available from the provider's application and the risk category can be derived by the Provider Enrollment module before calling the PSV API. (slide 1)

• Do we know of a COTS/GOTS/OS instantiation of Provider Management against which we can test that part of the API?

CAQH: We believe any existing Provider Management vendor/module can help test the API.
-- followup: Is there a preferred one to start with? Seem to recall something is/will be available from GDIT.

Additional Q&A:

• The focus seems to be on the Individual, although there is some Organization info. Do we need separate APIs for the Individual and for the Organization?
  -- Likely just additional fields. Some services (checks) are for Individuals, some for Organizations. Will need logic to apply relevant checks.

• Do we need to to enroll the Organization separately from individual providers making up organization? Is this state-dependent? How and under what circumstances do we need to connect an Individual with the Organization they are part of? Do we need to connect the Individual with multiple Organizations?
  -- Do existing systems worry about this?
  -- Does Organization screening require screening of Individuals in Organization? If so, which Individuals?
  -- PSM work now looking into this.

• Do we need SSN in addition to National Provider Identifier (NPI)? Are there special concerns in handling SSNs?
  -- Some things require SSN.