Page tree
Skip to end of metadata
Go to start of metadata

Chair:  Robert DieterleViet NguyenAnupam Goel

Scribe: Dana Marcelonis
 


Attendees

Present

Name

Affiliation

  •  
Enablecare
  •  
Stratametrics
  •  
Dana MarcelonisPoint of Care Partners
  •  
Tony BensonBCBSAL
  •  

Emily Calvert

CMS
  •  

Erica Ross

CMS
  •  
HeatherAMA
  •  
Joseph QuinnOptum
  •  

Kelly Anderson

BCBSAL
  •  
Lynda RoweInterSystems
  •  

Mark Mundt

InterSystems
  •  
Megan SoccorsoCigna
  •  

Mike Funk

Humana
  •  
Nancy SpectorAMA
  •  
Terry CunninghamAMA
  •  
Tori WillowsWellcare
  •  
BCBSFL
  •  
Aim/ Anthem
  •  

Marci Maisano

Cigna
  •  
Edifecs
  •  
Lindee ChinEdifecs
  •  
Anupam GoelUnited Healthcare
  •  
Anthem
  •  
Christy Dodson
  •  
Kevin LambertBCBSAL
  •  
Laura Hoffman
  •  
Laurie Burckhardt
  •  
Optum
  •  
Lindee ChinEdifecs
  •  
Lorraine DooCMS
  •  
Peter MuirESAC
  •  

  •  
Raj
  •  
Ray WilkersonScope Info Tech
  •  
Susan LangfordBCBST
  •  
Taha AnjarwallaCAQH
  •  
Tom
  •  
Sonja Ziegler
  •  
Clayton LewisIntersystems
  •  
NandiniEMDI/ Scope Info Tech
  •  
John BialowiczBCBSM
  •  
Kasi
  •  
EMDI Team
  •  
Alberto S. LlanesAnthem
  •  
Bart CarlsonAzuba
  •  
David DeGandi Cambia
  •  
Duane WalkerBCBSM
  •  
Russell LeftwichInterSystems
  •  
Jim Taylor
  •  
Louis BedorCognosante
  •  
Mary L. BushmanAnthem
  •  
Melanie Combs-DyerCMS
  •  
Michael CabralCMS
  •  
Michael Gould IBC
  •  
Sudhir NairAnthem
  •  
Rian
  •  

  •  
Sandeep
  •  
Sreekanth

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy



ONC and CMS NPRM Impact
  • September ballots tend to get reconciled and published well into the first quarter of the year (Feb/ March) - this is too late to provide guidance to the industry/ payers on requirements in the CMS NPRM
  • Proposed an early ballot for September to HL7 Technical Steering Committee (TSC) - would take place a month earlier than the standard ballot in July
  • HRex, CDex, PDex, and Prior Authorization Support would be moved to an early September STU1 ballot in July
  • Concern re: 4 IGs in short timeframe - possible refactoring later
    • Early September ballot would be version 1, we'll receive industry feedback for the next version
    • The industry won't have any basis from which to work if we slow this down


Scope of interaction with provider

Provider Interactions

  • Ask if provider wants to initiate SMART on FHIR App/ Prior Auth application (e.g., if card comes back and says PA is required, click here to initiate review of the record)
    • Option to queue as a task for someone else in the practice
      • Needs to be configurable because there will be some practices that insist the provider do this at time of service
      • May also depend on type of service
    • Option to queue a task for someone else in a different practice - for example, the servicing provider (e.g., lab) needs to submit the prior auth, but they may need some information from the ordering provider (e.g., PCP) in order to complete that prior auth
      • How would all stakeholders get access to the app? Web service, HIE, EHR to EHR, Patient Cloud...
      • Key is that the app is accessible via provider's central workflow
      • Need to provide guidance for each workflow - ordering provider and servicing provider (or either/ or can do the prior auth)
  • If all information is available in the patient's record
    • Provider must have the ability to review before submitting since they are attesting to the information - option to 'sign'
    • Need option to cancel
    • Option to queue for someone else to submit
  • Prior Auth needs to be accessible post-submission
    • Need to account for multiple reviewers, multiple versions
    • Ability edit - change servicing provider, counts, additional services, changes in vendors, update timeframe
  • Request "missing" information

Management Next agenda
  • Discussion of workflow options
  • Discussion of information required for payer processing
  • Use of Claim resource and next steps

 Adjournment
 Adjourned at 4pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Tasks

  •