2020-04-06 Meeting Agenda

Mike Gould

PIE will manage the meetings for:

1. Subscriber and Dependent issue for all - except Medicare Advantage or Medicare FFS 
   1. Layout the examples. Pat, Bob, Christol, Paul, Durwin.

Documentation start for the coverage resource may be:  Coverage Identifiers: FHIR R4 Member Identifier, Subscriber ID, Dependent Number

One Example: How to get all the claims for johnny on mom's phone? and then what happens when johnny turns the magic age of 'owner of his data'

johnny who is covered with 3 insurances. Mom, Dad & a state program

2nd example:  Grama wants son to have access to her claims (Proxy or health care oversight person/caregiver)

1st call 4/7/2020: 3:30ET/2:30Central/1:30Mt/12:30Pacific. Begin the examples.

2. Coordination of Benefits.  Any related challenges from secondary insurance on any of the CMS rule related efforts.

Bob D: If the only member that has portal access is the "Subscriber", and they have multiple dependents who are of appropriate age to have rights to their data, how do you deal with authorization (when they don't have portal access)?

• Amol - it's going to involve tying the identity provider to those dependents who are entitled to create accounts.  For dependents that are lower than the age allowed for data access, the Subscriber acts as their proxy and has access to the dependent data.
• Once authorized, an app is issued a token including details including MemberID for the user who authorized it

Bob D: What do you do for a payer organization that has not created a MemberID for all dependents?

• Amol - you have to assume that payers create MemberIDs for at least everyone who is empowered to have access to data on the portal

Bob D: I think we'll find that not all payers are doing this