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Chair:  Robert DieterleViet NguyenAnupam Goel

Scribe: Linda Michaelsen
 


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
  •  
Nandini GangulyEMDI/ Scope Info Tech
  •  
John BialowiczBCBSM
  •  
Kasi
  •  
EMDI Team
  •  
Alberto S. LlanesAnthem
  •  
Bart CarlsonAzuba
  •  
David DeGandiCambia
  •  
Duane WalkerBCBSM
  •  
Russell LeftwichInterSystems
  •  
Jim Taylor
  •  
Louis BedorCognosante
  •  
Mary L. BushmanAnthem
  •  
Melanie Combs-DyerCMS
  •  
Michael CabralCMS
  •  
Michael GouldIBC
  •  
Sudhir NairAnthem
  •  
Rian
  •  

  •  
Sandeep
  •  
Sreekanth PuramMettle Solutions
  •  
Jeffrey DanfordAllscripts
  •  
James Gallagher Jr.Premera
  •  
Joseph Figueroa
  •  
Tony LittleOptum
  •  
Pallavi TalekarScope Info Tech
  •  
Thomas KesslerCMS
  •  
Todd Omundson
  •  
Tony ShengZeOmega
  •  
Karen L. ZapataAnthem
  •  
Rachel GoldsteinCAQH
  •  
Ralph Saint-PhardHealow
  •  
Susan LestinaAHA
  •  
Briana BarnesScope Info Tech
  •  
Hans Buitendijk Cerner
  •  
Cassandra Bell
  •  
Deepthi ReddyMettle Solutions
  •  
Cognosante
  •  
Patrick MurtaHumana
  •  
Prashanth Golconda
  •  
Rajesh Godavarthi
  •  
Rim Cothren
  •  
Scott LawrenceCMS






Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



HITAC Presentation
  • Reviewed Presentation from HITAC
    • three slide decks will be posted to Confluence after today’s meeting


Prior Auth Workflow
  • Attachment would have to be a CCDA Header with any attachment including FHIR Resources (comment by John Kelly)
  • Showed workflow with rules from CRD/DTR/Prior Auth Support – not labelled as such for HITAC
  • Question about CDS Hooks
  • Rachel asked can CRD do a Prior Authorization on its own and Bob said yes
    • It isn't documented in CRD but can still be done
  • FHIR, CDS Hooks, Smart on FHIR and CQL could significantly reduce time in clinical workflow
  • Bob will clarify slide 20 based on Rachel Foerster's Comments
  • Rachel asked if Practice Management System should show
    • if well integrated easier
    • if not will be more challenging; need to think about
  • Rachel sending a list of Core Resources from CAQH X278 to Bob
  • Updated classes
  • Discussed recurrent episodes - once to lifetime like Oxygen or services for person with ALS or PT or Diabetic testing supplies, transportation/non-emergent, Medication Assisted Therapy (MAT)
  • Who can ask for Prior Authorizations
    • Service/Rendering Provider is typical in Medicare FFS
    • Some allow Ordering or Rendering - Scott Lawerence checking for CMS (
    • This issue affects lab - suggest we get a contact from lab
  • Use Case - one provider gets the PA but has to send another provider


ConnectathonBriefly discussed thinking about what PA would do at Connectathon
Management Next agenda

 Adjournment
 Adjourned at 

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Tasks

  •