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Chair:  Dr.Nita Thingalayaand Dr. Julia Skapik

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

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

Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  

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Pallavi TalekarScope Info Tech
  •  
Julia SkapikCognitive Medicine
  •  
Kelly TaylorCMS
  •  
Karen L. Zapata Anthem
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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



Ballot and Connectathon Schedule
  • Jacksonville Connectathon - May 29-30
  • 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


Jacksonville Discovery Session
  • Topics discussed in Jacksonville:
    • Drivers
    • In Scope
    • Out of scope
    • Scenarios
      • Primary: Member moves from one covered plan to another covered plan, and requests transfer of data from old plan to new plan
      • Member and dependents move
      • Dependent only move
      • Legal representative authorized member data exchange
      • Member moves from covered plan to non-covered plan or from non-covered plan to covered plan
      • Break in qualified plan (e.g., MA-FFS-MA)
      • Member adds coverage
      • Etc.
    • Scenario Workflow
      • Member moves to new covered payer
      • Member authorizes new payer to receive decision records from old payer
      • New payer requests data from old payer
      • Old payer "sends" payload to new payer
      • New payer receives data
    • Patient Authorization Workflow
      • Assumption re: member still having access to old payer portal - typically terminated when member is no longer covered
      • Add Assumption: new payer has integrated with old payer?
        • New payer app has to be registered with old payer
        • Example: New payer portal has an option to request data from prior payer
          • List of apps integrated and approved
          • Process like Apple, Blue Button - sign onto your old portal and authorize that application for the new payer to get your data
      • Member-directed/authorized exchange
      • Prior Authorization from old payer doesn't have to become active for the new payer - the information just needs to be shared so they know that one existed, and don't have to ask the provider for the same information again
    • Information requirements - information exchanged between payers
    • Data elements
    • Encoding guidelines
      • Limiting scope to guidelines that can be electronically referenced
    • Was there conversation re: payer 1 sending medical records to payer 2?  Or no medical records, just data?
      • With member-directed exchange based on current NPRM, data is part of USCDI and would be exchanged based on a document reference (to exchange any aggregated sets of data)
      • Just the data that's needed that's relevant to the particular active treatment or approval/decision
    • Follow Up Actions
    • Parking Lot Items
    • Create 3 clinical scenarios that we could use to look at the data elements/information requirements
      • Example of patient with respiratory condition and need for oxygen
      • Diabetes, requiring ongoing medical supplies
      • Transplant patient - multiple medical needs with ongoing payer case management
    • Partipant request to share workflow/data examples
  • Content will be posted to Confluence 

ManagementNext agendaDiscuss 3 clinical scenarios proposed as examples
 Adjournment
Adjourned at 2:51pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Action items


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