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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
  •  
Betty SullivanAllscripts


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
Julia and MarkConnectathon Logistics

Virtual Connectathon Logistics: Payer Coverage Decision Exchange Virtual Logistics

Issue tracking: Implementation Guide Content Workspace

  • Virtual Connectathon will begin with everyone on the same line, then will break out into separate dial-ins per track
  • Let us know you're participating, so that we can send you the meeting invitation for the virtual connectathon
  • Rough agenda included on Da Vinci Virtual Connectathon sign up page

Dave/JoeRI Update
  • Ability to create/assemble a document and then see the content on the receiving side
  • Virtual Connectathon - more of a focus on content
    • Created HSPC sandbox instance to allow for exchange of documents that either sending payers or receiving payers are able to share as they participate in the connectathon
    • Creating 2 examples to start that conversation:
      • Co-morbid condition of COPD and sleep apnea
      • Type 2 Diabetes
      • Prior Authorization is embedded into the use case examples
        • What does Prior Auth look like as a payer, instead of from a provider?
    • Goal to see if payers can map these items
    • Follow ups will determine how we can make it more sophisticated
    • Testing content and interactions to move the content

May and JuliaUse Cases Test Data

Payer Coverage Decision Exchange Use Cases

  • Need input from payers
  • Diabetes care management program - looking for codes to describe case management
    • CMS pays for chronic care management and it requires person to be supervised by physician or other authorized provider if the person providing case management is not the authorized provider
  • How to code a prospective service/procedure? It hasn't been performed/billed yet
  • Need some payer coding expertise for this conversation - medical reviewer
  • Need to know where this information lives

ManagementNext agenda



 Adjournment

Adjourned at 3:03pm ET


Supporting Documents


Action items


Create Decision from template