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Chair:  Robert DieterleViet NguyenAnupam Goel

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

  •  
Enablecare
  •  
Stratametrics
  •  
Point of Care Partners
  •  
BCBSAL
  •  

Emily Calvert

CMS
  •  

Erica Ross

CMS
  •  
HeatherAMA
  •  
Optum
  •  

Kelly Anderson

BCBSAL
  •  
InterSystems
  •  

Mark Mundt

InterSystems
  •  
Megan SoccorsoCigna
  •  

Mike Funk

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

Marci Maisano

Cigna
  •  
Edifecs
  •  
Edifecs
  •  
United Healthcare
  •  
Anthem
  •  
Christy Dodson
  •  
BCBSAL
  •  
Laura Hoffman
  •  
WPS Health Solutions
  •  
Optum
  •  
Edifecs
  •  
CMS
  •  

  •  

  •  
Raj
  •  
Ray WilkersonScope Info Tech
  •  
BCBST
  •  
Taha AnjarwallaCAQH
  •  
Tom
  •  
Sonja Ziegler
  •  
Intersystems
  •  
Nandini GangulyEMDI/ Scope Info Tech
  •  
BCBSM
  •  
Kasi
  •  
EMDI Team
  •  
Anthem
  •  
Bart CarlsonAzuba
  •  
Cambia
  •  
Duane WalkerBCBSM
  •  
InterSystems
  •  
Tibco
  •  
Louis BedorCognosante
  •  
Anthem
  •  
CMS
  •  
CMS
  •  
IBC
  •  
Anthem
  •  
Rian
  •  
Palmetto gba
  •  
Sandeep
  •  
Sreekanth PuramMettle Solutions
  •  
Allscripts
  •  
James Gallagher Jr.Premera
  •  
Joseph Figueroa
  •  
Tony LittleOptum
  •  
Pallavi TalekarEMDI/ Scope Info Tech
  •  
Thomas KesslerCMS
  •  
Todd Omundson
  •  
ZeOmega
  •  
Emily TenEyckCAQH
  •  
Mark Taylor
  •  
Julia Skapik
  •  
Michael BrodyCME Online
  •  
Michcelle ZuttermanHumana

Present

Name

Affiliation

  •  
Anthem
  •  
Rachel GoldsteinCAQH
  •  
Ralph Saint-PhardHealow
  •  
Susan LestinaAHA
  •  
Briana BarnesScope Info Tech
  •  
Cerner
  •  
Cassandra Bell
  •  
Deepthi ReddyMettle Solutions
  •  
Cognosante
  •  
Humana
  •  
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
  •  
SureScripts
  •  
Gevity
  •  
Melanie JonesCMS
  •  
eClinicalWorks
  •  
Tammy SchreinerWPS Health Solutions
  •  
Amy PetersonHumana
  •  
Dave Trotter, MD
  •  
BCBSIL
  •  
Renee Fuller
  •  
Helina Gebremariam
  •  
Cambia
  •  
Intepro
  •  
Carradora
  •  

  •  

  •  
MaxMD
  •  
Cindy Monarch BCBSM
  •  
Dawn PerreaultBCBSM
  •  
Cognizant
  •  
Mitre
  •  

  •  
Missy BoserSurescripts
  •  
CAQH
  •  
Phranil MehtaeClinicalWorks
  •  
Dylan TuggleBCBST
  •  
JPSys
  •  
Mario JarrinChange Healthcare
  •  
Jim AdamsonArkansas Blue Cross
  •  
Brian PoteetBCBST
  •  
Tony LaurieNoridian
  •  
Optum
  •  
Bonnie SirottZeOmega
  •  
MCG
  •  
ESAC
  •  
Geeta KrishnanEdifecs
  •  
Katherine LuskChildrens
  •  
Michael NovalesBCBSIL
  •  
Tracey McCutcheonKPMG
  •  
Anupam ThakurBCBS FL
  •  
Cathy PlattnerKP
  •  
Srinivasarao Eadara
  •  
Availity


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
  • Da Vinci Connectathon in Jacksonville, FL - May 29-30 - May Onsite Connecthon - Guidewell
  • Early ballot cycle schedule
    • NIB - May 19
    • Sign up for ballot opens - May 21
    • Initial content due - May 19
    • QA period - June 6
    • Final Content due - June 17
    • Ballot opens - June 21
    • Ballot closes - July 21
  • There's a possibility that we may push this IG to the September ballot instead of the early ballot cycle - we'll know more over the next couple of weeks


Survey update


Mapping update
  • Reviewed X12 278 loops/ segments - landing on the ones that need to be supported
  • There are a couple more that need to be supported
  • Attestation vs. structured data

    • There's something in between documented specific values for a lab test for example vs. a condition exists and there's accompanying information
    • From a commercial payer point of view, if only the ones with a specific diagnosis could be fully automated then most wouldn't be automated 
    • Tell me what's going on with the patient, and then let the payer rules engine make a determine based on that - this would support many real-time use cases
    • If it can be done in a questionnaire, great - it can also be done by accessing R4 US Core profiles on supported resources
  • X12 will make a common mapping available
  • Not available via HL7
  • Entire bundle of FHIR resources, including Prior Authorization profile on top of Claims, as well as Da VInci Coverage resource - base 64 encode it, and send the entire bundle via 275 BIN segment
    • Embed FHIR into CDA unstructured section? No - MIME type that allows for XML or JSON - this would require revision to CDA
  • Provider should be able to send 275 with CDA or FHIR bundle - Robert Dieterletalking to Division of National Standards
  • Technology between payers and providers already exists, but X12 278 is not widely adopted
  • What we're doing is compliant with current regulation and anticipated attachments rule
    • This could be implemented a different way, but wouldn't be consistent with current regulations
  • Da Vinci mapping will be done and then passed to X12
  • X12 gave specific project members permission to use TR3 to do the mapping, we're not able to discuss on the weekly conference call


WEDI Presentation
  • Reviewed Prior Authorization presentation done at WEDI
  • Robert Dieterle will ask WEDI if ok to post


Next agendaNext week's call is cancelled due to Da Vinci Connectathon and Working Sessions taking place in Jacksonville, FL May 29-31
 Adjournment
 Adjourned at 4pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Tasks

  •