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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 DodsonMCG
  •  
Kevin LambertBCBSAL
  •  
Laura Hoffman
  •  
Laurie BurckhardtWPS Health Solutions
  •  
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 TaylorTibco
  •  
Louis BedorCognosante
  •  
Mary L. BushmanAnthem
  •  
Melanie Combs-DyerCMS
  •  
Michael CabralCMS
  •  
Michael GouldIBC
  •  
Sudhir NairAnthem
  •  
Rian
  •  
Palmetto gba
  •  
Sandeep
  •  
Sreekanth PuramMettle Solutions
  •  
Jeffrey DanfordAllscripts
  •  
James Gallagher Jr.Premera
  •  
Joseph Figueroa
  •  
Tony LittleOptum
  •  
Pallavi TalekarEMDI/ Scope Info Tech
  •  
Thomas KesslerCMS
  •  
Todd Omundson
  •  
Tony ShengZeOmega
  •  
Karen L. ZapataAnthem
  •  
Rachel GoldsteinCAQH
  •  
Ralph Saint-PhardHealow
  •  
Susan LestinaAHA
  •  
Briana BarnesScope Info Tech
  •  
Hans BuitendijkCerner
  •  
Cassandra Bell
  •  
Deepthi ReddyMettle Solutions
  •  
Cognosante
  •  
Patrick MurtaHumana
  •  
Prashanth Golconda
  •  
Rajesh Godavarthi
  •  
Rim Cothren
  •  
Scott LawrenceCMS
  •  
Chris JonesHumana
  •  
Christina BorgLumeris
  •  
Julie MaasEMR Direct
  •  
Kathleen Connor
  •  
Matt ReidAMA
  •  
Mike BerkmanCoverMyMeds
  •  
Monse SerenilHumad
  •  
Rian RaineyCoverMyMeds
  •  
Sandra StuartKP
  •  
Sheryl TurneyAnthem
  •  
Wanda Govan-JenkinsHHS
  •  
Chris HutchinsonCoverMyMeds
  •  
Anna MeisheidCMS
  •  
Cyrus PeyrovianFastAuth
  •  
Janice BakosAetna
  •  
Joseph AthmanSureScripts
  •  
Lloyd McKenzieGevity
  •  
Melanie JonesCMS
  •  
Rohit ShindeeClinicalWorks
  •  
Tammy SchreinerWPS Health Solutions
  •  
Amy PetersonHumana
  •  
Cindy MonarchBCBSM
  •  
Dawn PerreaultBCBSM
  •  
James AndrewsAbility Network
  •  
Jeremy BarnardSurescripts
  •  
John DonnellyInterpro
  •  
Michael Flanigancarradora
  •  
Monse Serenil
  •  
Paul Knapp
  •  
Nita ThingalayaIBC
  •  
Jason WalonskiMitre
  •  
Didi DavisSequoia Project
  •  
Bruce B. SchreiberMaxMD

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Milestones
  • Mitre will be developing Reference Implementation
  • Gevity/ Lloyd McKenzie will be lead to author Implementation Guide

HL7 Connectathon (Montreal) - May 4-5

  • NIB - May 20
  • Jacksonville, FL Connectathon - May 29-30
  • Sign up for ballot opens - June 1
  • Initial content due - June 3 - may need to move these dates up a bit due to out of office schedules
  • Final Content due - June 24
  • Ballot opens - July 1
  • Ballot closes - July 30


Connectathon Links

Information required for processing 278
  • X12 is aware and supportive of what we're doing - we will work with them on mapping (outside of this use case call)
  • Payers could have multiple organizations doing UMO for them - would like to have a single endpoint going to the payer, and have the payer do the routing based on content of the request
    • Will need to determine if EHR needs to handle this
  • Patient Event Detail - review what parts of 278 are being used - Do organizations populate a subset of elements, or do we need to support everything?
    • Previous Review Authorization Number - assigned by payer/ UMO
    • Previous Review Administrative Reference Number
      • UMO/ payer may assign this, could be identifiers used between UMO and Payer
      • Need to allow the extension for it to happen
      • If you have to speak to someone in UM, they'll give you a number - could be directly with payer or 3rd party
    • If provider submitting PA for first time, they'll assign it their own tracking number
      • If additional documentation is necessary, provider needs a way to bring request/ additional information together, and this identifier will be used
      • If provider requests multiple PAs for one individual, tracking using internal identifiers until they have been approved and have the payer identifier
      • This may be solved by Unique URL Identifier for resource they're sending
    • 278 is not a 'chatty' exchange - you submit all the information when provider makes the request
      • "Chattiness" needs to occur in CRD/ DTR process
      • Issuer puts their identifier on the authorization upon submission, and then receives the payer's identifier in response
    • Accident Date - date of car accident, etc. and is being used
      • Already exists in the Resource
    • Last Menstrual Period Date and Estimated Date of Birth - important for NICU admissions, PA for Amniocentesis
    • Healthcare Services Delivery - frequency/ rate of what provider is requesting
      • This information should be at same level as services being performed
      • 278 has concept of service type (e.g., OT) - could ask for 21 visits, but don't need to use CPT/ HPCS to make request
      • This doesn't exist in FHIR resource today
      • There's a need for this information, but may need additional detail
      • HCPCS code is not sufficient; we need something to report pattern or usage
    • Should we be able to support everything in the 278 in FHIR? These elements were added to the X12 for a reason
      • Implications of making this decision - we are going to extend FHIR to support it, and create a way to query this information from the provider or someone else in their office because it's necessary to populate these fields - is this work we need to do that nobody will use?
      • Perhaps we could prioritize by volume to determine what we tackle first
      • Within Claim Resource, there's additional supporting information that has a pattern that many of these things could potentially fall into
        • Work would be to determine what could be mapped into that pattern
      • What are we doing between now and the ballot in July?  Will need to defer some items
      • Will add these questions into the participant survey
      • Will review this offline and bring back to the group

Management Next agenda
  • Detailed deep dive on DME use case next week

 Adjournment
 Adjourned at 4:06pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Tasks

  •