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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
  •  
Gevity
  •  
Julia ChanCW Global Consult
  •  
Ken Lord
  •  

  •  

  •  
Roland Gamache
  •  


  •  


  •  


  •  


  •  



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


PCDE Implementation Guide Review

  • Reviewed PCDE workflow
  • Indicate that authorization is dependent upon CMS’ final rule
  • First authorization step could be optional, or removed entirely
  • Mechanism for request is the same in that the new payer sends a communication request to the old payer
  • If the old payer always prepares that as the member leaves, the document would be available immediately – would we still use Communication?
    • Yes, because there’s no way for the new payer to be confident that the document they’d find in a query might be a couple years old is current – they don’t know if anything relevant has happened since that document was prepared
    • Request would ask payer to prepare a current one – if what they have is current, that would get pushed immediately – if there’s more to be done to update it then that would need to happen first
  • Sharing USCDI equivalent of claim, but not claim itself – don’t want to share financial information that goes with it
  • Is expectation that payers are translating ICD-10 that came in the claim to a SNO-MED code?
    • Ramification of relying on US Core Profiles – must translate to SNO-MED to comply with this profile
    • Can send ICD-10 also, but must have SNO-MED
    • Medicaid agencies for plan transfers, won’t be able to use this
    • Recommend that this needs to deviate from the US Core Profile
    • We’re using Argonaut profiles in a way that wasn’t intended
    • Breakout at Connectathon to discuss putting payer data into a resource that was designed for clinical information?
    • This is payer to payer communication – we need a different profile for this
    • Recommend not using Argonaut Profile – will need to be a ballot comment since we can’t make that kind of change at this point in development of the IG
      • What would we need to move to? Bigger debate about creating higher level profiles?
    • If the fundamental issue is code sets, why can’t we use the US Core Profile and modify it so that most of it is the same, and the only things we care about are different?
      • We could do that, but politically and procedurally there may be some differing opinions
      • Connectathon process and payers actually trying to implement using existing data will identify if there are any other challenges/ constraints
        • US Core Profiles might be overly restrictive
        • US Core Profiles may be silent on things that would be useful to have (items/rules that enforce consistency on data elements that are critical to have)
      • Need to have conversation outside of Connectathon re: vocabulary with business SMEs who understand vocabularies, not only developers
    • Viet/Bob to schedule a Payer/Provider vocabulary weekly session
      • How do we define procedures, diagnoses, etc.
      • HL7 as an organization will also need to figure out how do we want to manage this and maintain alignment moving forward
        • Higher level profile with sub-sets?
        • Forks that stay aligned?
      • HL7 conversations already taking place re: needing to create base profiles because US Core Profiles are too restrictive
      • We could reuse PCDE call during ballot voting period to discuss evaluation of US Core Profiles and ability for them to convey payer data structures (including vocabulary and other issues)
      • Mary Kay McDaniel, Laurie Burckhardt (Dana forwarded them the call), Julia, Nita, Bob, Viet to discuss in Thursday PCDE working session call
    • Reminder to sign up for September ballot by August 8th
    • Comments should be added as a ballot comment or an issue in gforge at this point, unless it’s minor QA issue that can be corrected prior to ballot
    • Examples are included in the IG – sample Communication Request and Communication Response
      • Feedback needed, more examples would be welcome

ManagementNext agenda



 Adjournment
Adjourned at 2:58pm ET

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