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Chair:  Dr.Nita Thingalayaand Dr. Julia Skapik

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

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Robert DieterleEnablecare
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Stratametrics
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Nita ThingalayaIBC
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Cambia Health Solutions
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Duane WalkerBCBSM
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Gregory MagazuCaseNet
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Jeanie SmithBCBSFL
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Corey SpearsInfor
  •  
Greg Linden
  •  
Joseph QuinnOptum
  •  
Ashley SteddingCMS
  •  
Barbara AntunaAIM Specialty Health/ Anthem
  •  
Mary Kay McDanielCognosante
  •  
Michael GouldIBC
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Laurie BurckhardtWPS Health Systems
  •  
Serafina Versaggi
  •  
Sreenivas MallipeddiMCG Health
  •  
Susan BellileAvaility
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Susan LangfordBCBST
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Taha AnjarwallaCAQH
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Tony BensonBCBSAL
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Tracey McCutcheonKPMG
  •  
Brent WoodmanBCBSM
  •  
Sonja ZieglerOptum
  •  
Dawn Perreault
  •  
CMS
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Minutes Approved as Presented 


This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Introductions

Da Vinci PMO

Project Leadership

  • Participant introductions


Implementation Guide and Reference Implementation 
  • Implementation Guide will be developed by Gevity - Lloyd McKenziewith support from Jean Duteau
  • Reference Implementation development - TBD
  • Payer Coverage Decision Exchange - portability of treatment information across health plans


Da Vinci Overview
  • Da Vinci defines specific use cases that are important to interoperability, particularly between payers and providers
  • Define business, technical, and testing requirements
  • Create Implementation Guides with intent to ballot via  HL7 and publish as standards
  • Create Reference Implementations to exercise the Implementation Guides to make sure that the IGs work in practice
  • Da Vinci members are payers, providers, EHR vendors, payer IT vendors


Implementation Guide Overview
  • Implementation Guides that have already been ballotted 
    • Data Exchange for Quality Measures (DEQM) 
    • Coverage Requirements Discovery (CRD) - ability for providers (in workflow) to ask payers if there's something they need to do (e.g., documentation, prior authorization, etc.) in order to complete their order, or other activity 
    • Documentation Templates and Coverage Rules (DTR) - ballot for comment- expressing payer rules (e.g., need for documentation or prior authorization) in the context of clinical workflow
  • Implemtnation Guides scheduled for Early Ballot (June 21)
    • Health Record Exchange Framework (HRex) - work to take common FHIR standards, profiles, extensions, operations and put them in one place, document how to use, and re-use throughout other implementation guides
    • Clinical Data Exchange (CDex) - exchange provider information with another provider or payer upon request
    • Prior Authorization Support - extends DTR - assemble the information required for Prior Authorization, the information to populate the X12 278 and 275 transactions, and send to payer in real-time 
    • Payer Data Exchange (PDex) - making payer information available to providers upon request; making payer data available to a 3rd party application, or exchange with another payer when the member moves to a new payer
    • Payer Data Exchange (PDex): Directory - making payer provider network information available to member or 3rd party application
    • Payer Data Exchange (PDex): Formulary - making formulary information available for Medicare Advantage members participating in PArt D or drug plans
  • Implementation Guides for September ballot
    • Documentation Templates and Coverage Rules (DTR) - STU
    • Alerts/Notifications - using FHIR instead of v2 to alert extended care team when something has occurred (admission, discharge, change in treatment, etc.)
    • Payer to Payer Coverage Decision Exchange - provider info necessary to describe current treatment for a member based on their clinical conditions and the basis on which Prior Auth was evaluated


Work breakdown with CARIN Alliance
  • Claims data
    • Financial - EOB - CARIN - payer to member exchange
    • Clinical - USCDI/ US Core - Da Vinci (PDex) - payer to member, payer to payer, or payer to provider
  • Pharmacy data
    • RTBC - CARIN NCPDP
    • Medications - Da Vinci build (DV for CARIN for payer to member exchange)
    • Formulary - Da Vinci build (DV for CARIN for payer to member exchange)
  • Directory - Da Vinci build (DV for CARIN for payer to member exchange)
  • See slides for additional information


Ballot and Connectathon Schedule
  • Jacksonville Connectathon and working sessions - May 29-31
  • Goal is to ballot for September ballot cycle
    • Jun 30th -- NIB
    • Jul  14rd – Initial content
    • Jul 21st - Ballot Review Period Starts
    • Aug 4th – Final content
    • July 8th - Ballot sign up starts
    • Aug 9th – ballot voting starts
  • HL7 Atlanta Connectathon - end of September


Payer Coverage Decision Exchange Overview
  • Addressing the intent of CMS NPRM language regarding portability of treatment information across payers as members move
    • PDex is focused on payer to payer, member-directed exchange, which is for USCDI only (CMS NPRM regulatory requirement)
    • The above doesn't cover the rationale for why something is covered/ decision process
    • Goal is to not have member treatment stop and start as they switch payers
    • Also don't want to ask for provider information that was already furnished
  • Support for exchange regarding ongoing treatment
    • Information
      • Relevant diagnoses
      • Current treatments
      • Guidlines for Prior Auth
      • Clinical information that went into the decision for treatment coverage
    • Exchange methods
      • Member-directed exchange (e.g., Blue Button 2.0 or Apple health record)
      • Member authorizes the new payer to use their API to reach into previous payer's data
  • PSS has been submitted to HL7
  • FHIR IG Proposal has not yet been submitted


Confluence LinksPayer Coverage Decision Exchange Supporting Materials
ManagementNext agenda

 Adjournment
Adjourned at 2:46pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Action items


Create Decision from template