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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
  •  
Allscripts
  •  
BCBSM
  •  
Chris JohnsonBCBSAL
  •  
MITRE
  •  
ZeOmega

Present

Name

Affiliation

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

  •  
Roland Gamache
  •  
Alberto S. LlanesAnthem
  •  
Mark ScrimshireNew Wave
  •  
EMR Direct
  •  
Patrick MurtaHumana
  •  
Ranjith KandurAnthem
  •  
Mitre
  •  
Joe Minieri
  •  
Dave Foster
  •  
Providence


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
MarkVirtual Connectathon 
May and JuliaScenario and RI questions
  • Identifiers patient
    • Required?
    • HRex Coverage Profile does not require Member ID
    • HRex requires Subscriber ID
    • EHR situations where it doesn't know the Member ID, but could use member name and DOB instead
    • If Payer to Payer scenario, they'll always have the Member ID
    • US Core doesn't require DOB
      • If payer has it they have to put it in
    • http://build.fhir.org/ig/HL7/US-Core-R4/StructureDefinition-us-core-patient.html

      • States for US-Core Patient: "The following data-elements are mandatory (i.e data MUST be present) or must be supported if the data is present in the sending system (Must Support definition)."

  • Coverage – HREX or PAS versions-- PAS is referenced in PCDE-- will comment that HREX should be the profile referenced
  • Terminology
    • Procedures
      • CPT, HCPCS, and SNOMED
      • L codes
    • Meds
      • RX Norm as primary, but NDC as alternate
    • Devices
      • SNOMED as primary
      • Code for device itself, not the procedure - UDI
        • Not every payer has UDI
      • DI in codable concept
      • HCPCS could go into codable concept
    • Therapies
      • Behavioral
      • Allied
      • Care Mgmt

ManagementNext agenda



 Adjournment

Adjourned at 2:56pm ET


Supporting Documents


Action items


Create Decision from template