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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 PerreaultBCBSM
  •  
CMS
  •  
Anupam ThakurBCBS FL
  •  
Anthem
  •  
Jeffrey DanfordAllscripts

Present

Name

Affiliation

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

  •  
Pallavi TalekarScope Info Tech
  •  
Julia SkapikCognitive Medicine
  •  
Kelly TaylorCMS
  •  
Karen L. ZapataAnthem
  •  
Brandon RaabAnthem
  •  
Cindy MonarchBCBSM
  •  
Michael CabralCMS
  •  
Nick RadovUHC
  •  
Anne MeisheidCMS
  •  
Isaac VetterEpic
  •  
James Derrickson
  •  
Laurie WoodromeLabcorp
  •  
Ric LightHumana
  •  
Harvey KuangExpress Scripts
  •  
BCBS AL
  •  
Cloud Cray
  •  
Deryl Lam
  •  
Edifecs
  •  
NewWave
  •  


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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


ManagementBallot and Connectathon Schedule
  • September ballot cycle
    • Jun 30th -- NIB
    • July 8th - Ballot sign up starts
    • Jul  14th – Initial Content IG
    • Jul 21st - Ballot QA Period Starts
    • Aug 4th – Final content
    • Aug 9th – ballot voting starts
  • HL7 Atlanta Connectathon - Sept 14-15


Review a use case for continuity of treatment and how it would populate the Care Plan resource
  • Patient iniates a transfer from old payer to new payer, including their treatments
  • Care Plan includes a textual description of what's going on with the patient
  • Participant Role code set - does not include a code for payer (or at least not a typical US payer)
    • We'll need to gather a reasonable set of roles that would come from the payers and include them
    • Case Manager code is relevant to payer
    • Payer codes exist elsewhere, just not in this particular code set
    • There could be multiple payers, so if we add it we need to think about primary and secondary (e.g., married couples)
    • Discussion in Attachments workgroup - payers would need to get an OID? Most payers were not going to get an OID to do their attachments 
    • Do we have this issue on Prior Authorization Support? What are we doing for that use case?Julia Skapik to follow up with Robert Dieterleand Lloyd McKenzie
      • Assumption made was that transaction is between the provider and the payer - it's up to the payer to share if there are 3rd parties who need the PA information
    • Binding strength if we create our own value set?
    • Would payer authors be individuals or organizations?
    • Definition of payer - does it include self-funded groups?
    • Consider vendors and benefit managers as part of value set
  • Can list providers who have a role in the patient's care at the care plan level, or just in reference to specific treatment activities
    • Payers store providers (or provider organizations) at patient level and at treatment level to satisfy different use cases
    • Diabetic patient will have PCP and an Endocrinologist - Endocrinologist will be associated with certain blood tests, and the PCP will be associated with different blood tests, or there may be overlap where PCP orders some of the same stuff
    • Add payer care manager to the example
    • Can we be more general? List names as required as part of a provider team/group - ability to add/change names
      • Don't want to add complexity of in/out of network?
  • How do we cross-pollinate across use cases? Want to make sure they stay aligned, and don't conflict
  • Conditions
  • Goal is 'nice to have' - won't always be populated
  • Activity
    • Where does prior auth information go?
      • This should be specific to activity
      • CarePlan.activity.detail.description - not sure if this supports an attachment - Julia Skapikwill follow up with Mark Scrimshire
      • reason.reference vs. description.detail?
    • How to code information re: medications
      • RxNorm is strongly preferred - better aligned to CCDA 2.1
        • Level of specificity for RxNorm?
          • Look at PDex Formulary IG
      • NDC code could be included as a translation
      • ISA has recommended code systems

ManagementNext agenda

Call cancelled July 5th due to holiday weekend

Following week we'll continue with additional examples


 Adjournment
Adjourned at 3:01pm ET

Supporting Documents


Action items


Create Decision from template