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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
  •  

  •  
June Bronnert
  •  
Parthiban


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

Links

Virtual Connectathon Logistics: Payer Coverage Decision Exchange Virtual Logistics

Issue tracking: Implementation Guide Content Workspace

Payer Coverage Decision Exchange Use Cases



Virtual Connectathon Update/ To Do's
  • Were able to validate bundle
  • Need clarification of examples in IG
    • Need to submit a valid patient identifier to the old health plan to request a coverage transition document
    • IG refers to use case scenario in CDex IG, but needs to replace it with a different coding to request a coverage transition document
    • No established code for that transition document
  • CommunicationRequest and CommunicationResponse
    • CommunicationRequest needs that patient identifier - works if you have a member-authorized exchange
    • Need clarification that requesting plan, when it gets a member authorization and token back from the target plan, probably need to pull the patient resource so they have the patient identifier to incorporate into the CommunicationRequest
    • Patient identifier is in the example - assumes you have the patient FHIR record in that target plan
    • Is there a case where you'd submit a search against Coverage resource to identify the patient identifier
    • Same patient could have multiple plans with a given insurer
      • Need to use Coverage resource to identify the plan and the member
      • Don't want to add to Patient resource
    • Communication resource references the patient, Coverage also references the patient
    • Communication says, give me a document of this type - it doesn't say give me a document of this type for this patient
  • Challenge - want to do an asynchronous request where the document will either be created or existing document will be checked to make sure it's up-to-date, and then returned
  • PDex - able to request a document with this code, but it doesn't let you qualify what specifically you want to create
  • If we want to provide parameters re: what kind of document we want to create, CommunicationRequest may not be appropriate for this
  • Payload is what you want to be communicated, so Coverage can't be in the payload - you can put it in About
  • When a member has authorized the exchange, hand back the OAuth token, but pull patient identifier from that FHIR record so that it can be populated into the Communication
    • Then if you want to incorporate the Coverage resource alongside it you can
    • It may not be patient authorized though
    • When dealing with non-member authorized exchange, could query the Coverage resource in order to identify a patient record - that could be a standard method referenced by different IGs via HRex
      • This is creating a new process that doesn't exist
      • What really happens is you provide the member demographics and plan ID and then that's the basis for doing the match
    • Payers sometimes re-use Member IDs for the same person on different plans - sometimes if a person transfers from one plan to a different plan with the payer
    • Payers wouldn't re-use the Member ID for a different person
  • FHIR requires a patient ID - if you're going to link to anything in FHIR, you do it through Patient, not through Coverage
  • Before can create CommunicationRequest, need to know payer's member ID because the request is part of the patient's record
    • If the resource is patient-specific, it needs to be tied to the patient in FHIR
    • Sender system needs to put in their own ID, not the receiver's ID
  • CommunicationRequest coming from sender, needs to incorporate Patient resource for patient demographics
    • It would point to the resource, it wouldn't necessarily include the resource
    • When sending a bundle, you can either send a transaction, or send a straight bundle (just store it as is), or sending a message that says process this
  • CommunicationRequest has references to Patient, Coverage, etc. - it doesn't include any of those things
  • Take this discussion offline - FM workgroup meetings in Atlanta will discuss Da Vinci IGs


Implementation Guide Content Workspace
  • Goals-- would that ever be coded field?
    • Typically text data, but payers do have data to populate
    • Goals field within Care Plan resource
    • Could someone reference Goal resource instead of populating the field in the future?
    • Would want availability of a code and a string
    • Use Goal Narrative as Must Support
  • What kinds of documents would be attached and what type/format
    • JPEG and PDF
    • Structured Documents
    • Still have TIFs? 
      • Yes
      • Sometimes come from fax interfaces
    • Should be consistent with PIE/Attachments IG - 10 or so formats
      • These came out of unstructured body of CCDA - did they get carried over to FHIR?
      • FHIR allows you to send anything with a MIME type
      • Does US Core have constraints? No
      • Are there examples in PIE/Attachments IG?
      • Do we want IG to mandate support for certain attachment types or not?
        • PIE/Attachments IG does mandate
        • US Core does not
        • Consider mandating a minimum set of formats and not prohibit others
        • Receiver must support MIME types defined in the Attachments IG
    • Accident report could be in a TIF
  • Does it make sense for payer to keep information from previous exchanges?
    • Need to keep track of where data came from (prior payer)
    • New payer would probably want to pass data from prior payer on to another 3rd payer if the patient transfers again in a timeframe where data is still meaningful
  • Need to check that "active treatment" is actually reflected in FHIR 'Plan" and status "active"
    • Plan is an active plan - have to look within the plan at the particular treatment to check its status
    • Could have an active plan but a particular portion of the treatment is complete

ManagementNext agenda



 Adjournment

Adjourned at 3pm ET


Supporting Documents


Action items


Create Decision from template