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This call is at 2:30 PM ET, 1:30 PM CT, 12:30 PM MT, 11:30 AM PT

Join using: https://leavittpartners.zoom.us/j/461256971Meeting ID: 461 256 971

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Meeting ID: 461 256 971


  Agenda Outline

Agenda Item

  • Status of CARIN BB WG ballot reconciliation
  • Returning focal and reference resources as a bundle. Recommend defining an OperationDefinition resource in the IG. (FHIR-26702; FHIR-26693)
  • Recommend defining the following as Block-Vote-3:
    • PDex vs CARIN – FHIR-26699; FHIR-26733, FHIR-24842
    • Terminology and other tickets.
    • Type Claim definition FHIR-26777; FHIR-26708
    • Value Set – Data Absent Reason






                                                                                                                                                                                                                                                    


Recap

 

Status of the CARIN BB WG Ballot Reconciliation

 

CARIN BB JIRA ticket count

233

Duplicate tickets

26

Count of tickets to resolve

207

Ticket related to Issues Resolved in Block Vote 1

54

Ticket related to Issues Resolved in Block Vote 2*

29

Count of tickets proposed as Block Vote 3

64

Count of remaining tickets

60


Returning focal and reference resources as a bundle.  Recommend defining an OperationDefinition resource in the IG.  (FHIR-26702; FHIR-26693)

  • These tickets are included in Block-Vote-2; however, the solution of returning as if the request was _include=* is being revisited.  Recommend updating the disposition to define a custom resource, OperationDefinition
  • A server will support an "$assemble-eob" operation which will return for the specified patient all EOB resources matching the search request along with all the reference resources in the response bundle. Bundle.total will show a count of the EOB.
  • Some custom code would likely be required by the server, but this would also be required if _include=* was implied
  • ACTION ITEM: Will follow up on a question related to: If the operation does the same thing as search with _include=*, why not just write in the IG "clients must call search with _include=*"?

 

Payer Provisioning of Claims / Clinical data

  • Discussed including the following language to the IG in Block-Vote-3
    • CMS Guidance defines two sets of data be made available by payers in the Patient Access API:  1) Claims and Encounter Data and 2) Clinical data.  They provide links to specific implementations guides for the Patient Access API to provide guidance. Use of these implementation guides is not required, but if used these guides will provide information payers can use to meet the requirements of the policies being finalized. 
    •  CARIN BB IG defines how Claims and Encounter Data are to be provided; the DaVinci payer data exchange and US Core IGs define how Clinical Data is to be provided.  DaVinci and CARIN will be providing additional guidance on how the three IGs could be used by payers to meet the requirements of CMS Patient Access.  For claims us CARIN BB
  • Agreed to table this for a week and remove from Block-Vote-3


Terminology and Other Tickets 

  • The Financial Management Workgroup is addressing terminology value set / code system requirements.  In response to their request, 32 tickets were forwarded to them.  In preparation for the first release of a draft IG, dispositions have been proposed.  There are several other tickets related to the 32; dispositions have been proposed for them
  • We recommend these and other tickets for whom dispositions have been proposed be approved by the CARIN BB Workgroup and be included in Block-Vote-3

If a Value Set code cannot be assigned, include the data absent reason code set FHIR-26706

All required or must-support fields in the CarinBB IG will be bound with “Required” strength

When the payer’s data does not include a value from the Value Set and (i.e., a Plan assigned code for a procedure code) and a value is required [due to cardinality or must-support] the code “unknown” from the HL7 Code System, https://www.hl7.org/fhir/codesystem-data-absent-reason.html will be used.

Proposed disposition: Add the “unknown” code to each applicable Value Set. 

If this proposed resolution is adopted, the CARIN team would identify the applicable Value Sets to which this applies.  For example, Claim Type would not permit a data absent reason code. 






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