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Chair:  Robert DieterleViet NguyenAnupam Goel

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

  •  
Enablecare
  •  
Stratametrics
  •  
Point of Care Partners
  •  
BCBSAL
  •  

Emily Calvert

CMS
  •  

Erica Ross

CMS
  •  
Heather McComasAMA
  •  
Optum
  •  

Kelly Anderson

BCBSAL
  •  
InterSystems
  •  

Mark Mundt

InterSystems
  •  
Megan SoccorsoCigna
  •  

Mike Funk

Humana
  •  
Nancy SpectorAMA
  •  
Terry CunninghamAMA
  •  
Tori WillowsWellcare
  •  
BCBSFL
  •  
Aim/ Anthem
  •  

Marci Maisano

Cigna
  •  
Edifecs
  •  
Edifecs
  •  
United Healthcare
  •  
Anthem
  •  
Christy Dodson
  •  
BCBSAL
  •  
Laura Hoffman
  •  
WPS Health Solutions
  •  
Optum
  •  
Edifecs
  •  
CMS
  •  

  •  
CAQH
  •  
Raj
  •  
Ray WilkersonScope Info Tech
  •  
BCBST
  •  
Taha AnjarwallaCAQH
  •  
Tom
  •  
Sonja Ziegler
  •  
Intersystems
  •  
Nandini GangulyEMDI/ Scope Info Tech
  •  
BCBSM
  •  
Kasi
  •  
EMDI Team
  •  
Anthem
  •  
Bart CarlsonAzuba
  •  
Cambia
  •  
Duane WalkerBCBSM
  •  
InterSystems
  •  
Tibco
  •  
Louis BedorCognosante
  •  
Anthem
  •  
CMS
  •  
CMS
  •  
IBC
  •  
Anthem
  •  
Rian
  •  
Palmetto gba
  •  
Sandeep
  •  
Sreekanth PuramMettle Solutions
  •  
Allscripts
  •  
James Gallagher Jr.Premera
  •  
Joseph Figueroa
  •  
Tony LittleOptum
  •  
Pallavi TalekarEMDI/ Scope Info Tech
  •  
Thomas KesslerCMS
  •  
Todd Omundson
  •  
ZeOmega
  •  
Emily TenEyckCAQH
  •  
Mark Taylor
  •  
Julia SkapikCognitive Medicine
  •  
Michael BrodyCME Online
  •  
Michcelle ZuttermanHumana
  •  
Surescripts
  •  
Laurie DarstMayo
  •  
Marianna SinghCAQH
  •  
Labcorp
  •  

  •  
Mariana SinghCAQH
  •  
Madhuri
  •  

  •  
Bob THompson
  •  
Ben LangleyMITRE
  •  
Michelle PriestAllscripts
  •  
Michael Hurley
  •  
Cedars-Sinai
  •  
Roland Gamache
  •  
Dave HCRT INC
  •  
Barbara WoodPNC
  •  

  •  
Padma KondaveetiMettles

Present

Name

Affiliation

  •  
Anthem
  •  
Rachel GoldsteinCAQH
  •  
Ralph Saint-PhardHealow
  •  
Susan LestinaAHA
  •  
Briana BarnesScope Info Tech
  •  
Cerner
  •  
Cassandra Bell
  •  
Deepthi ReddyMettle Solutions
  •  
Cognosante
  •  
Humana
  •  
Prashanth Golconda
  •  
Rajesh GodavarthiMCG
  •  
Rim Cothren
  •  
Scott LawrenceCMS
  •  
Chris JonesHumana
  •  
Christina BorgLumeris
  •  
Julie MaasEMR Direct
  •  
Kathleen Connor
  •  
Matt ReidAMA
  •  
Mike BerkmanCoverMyMeds
  •  
Monse SerenilHumad
  •  
Rian RaineyCoverMyMeds
  •  
Sandra StuartKP
  •  
Sheryl TurneyAnthem
  •  
Wanda Govan-JenkinsHHS
  •  
Chris HutchinsonCoverMyMeds
  •  
Anna MeisheidCMS
  •  
Cyrus PeyrovianFastAuth
  •  
Janice BakosAetna
  •  
SureScripts
  •  
Gevity
  •  
Melanie JonesCMS
  •  
eClinicalWorks
  •  
Tammy SchreinerWPS Health Solutions
  •  
Amy PetersonHumana
  •  
Dave Trotter, MD
  •  
BCBSIL
  •  
Renee FullerIBX
  •  
Helina Gebremariam
  •  
Cambia
  •  
Intepro
  •  
Carradora
  •  

  •  

  •  
MaxMD
  •  
Cindy Monarch BCBSM
  •  
Dawn PerreaultBCBSM
  •  
Cognizant
  •  
Mitre
  •  

  •  
Missy BoserSurescripts
  •  
CAQH
  •  
Phranil MehtaeClinicalWorks
  •  
Dylan TuggleBCBST
  •  
JPSys
  •  
Mario JarrinChange Healthcare
  •  
Jim AdamsonArkansas Blue Cross
  •  
Brian PoteetBCBST
  •  
Tony LaurieNoridian
  •  
Optum
  •  
Bonnie SirottZeOmega
  •  
MCG
  •  
ESAC
  •  
Geeta KrishnanEdifecs
  •  
Katherine LuskChildrens
  •  
Michael NovalesBCBSIL
  •  
Tracey McCutcheonKPMG
  •  
Anupam ThakurBCBS FL
  •  
Cathy PlattnerKP
  •  
Srinivasarao EadaraesMD
  •  
Availity
  •  
ZeOmega
  •  
Dennis ZanettiNantHealth
  •  
Haris BegCambia
  •  
Kishore MetlaMettle Solutions
  •  
Sunitha Godavarthi
  •  

  •  
C-HIT
  •  
SriniesMD
  •  
Anthem
  •  
Kumar SourabhGRSI
  •  
Julia ChanCW Global Consult
  •  
Ric LightHumana
  •  
UHC
  •  
Anil VezendlaMCG
  •  
Ken LordBook Zurman
  •  

  •  
Christopher GraconIndependent Health
  •  
Gary GryanMitre
  •  
Mitre
  •  
Marty StaszakVoluware
  •  
Stephen ReckfordGRSI
  •  
Joe HamiltonUnity Point
  •  

  •  
Dave Foster
  •  
Betty SullivanAllscripts
  •  
Cigna
  •  
Juzer KhorakiwallaUHC
  •  
Unknown User (patricekuppe)Surescripts
  •  
Express-Scripts
  •  
Point of Care Partners
  •  
Celine LefebvreAMA
  •  
Eshaa DhalleClinicalWorks
  •  
Gay Dolin


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy



Milestones

Ballot comment review

#24198

  • Include security label in header or don't included contained resources
  • Do we need to defer until we see Security requirements that should be considered for all IGs?
  • Adhering to high watermarks covered in section on Security
    • If you have a resource or any package of information where some piece of the info is sensitive, then you have to treat the whole package that contains that information as sensitive in terms of determining who/where it gets exposed to, or data gets trimmed out of what's being shared
    • It's possible in FHIR to send resources as contained, where nesting one resource inside another - if patient's reosurce
  • Lloyd McKenzie will put together proposed resolution for review
  • Question re: PAS token issue
    • PAS does not include a token
    • CRD (uses CDS Hooks) and DTR (uses SMART) include tokens
  • Question re: overall flow
    • CRD uses CDS Hooks - as user is doing work, there are situations where there could be coverage implications or the payer knows something the provider/end user should know about (e.g, duplicative test that you're trying to order, prior authorization is required, etc.)
    • CRD may return a link to a DTR app for the user to complete prior authorization form
    • Submission could also come from the provider directly without the app
    • DTR may be grabbing certain information from the payer - a questionnaire to be filled out, or a rule set that needs to be checked in EHR - there's no data flowing to payer via DTR - if user wants to submit PA and send data to payer, it will launch the PAS process

#24178

  • PAS should call out expectations re: Minimum Necessary
  • Law says onus on requesting the minimum necessary is on the payer (CRD guide may say the onus is on provider)
  • 278 scenario - provider can send information and the payer can request more information (or let them know ahead of time what data is needed)
    • 278 is not carrying clinical data
    • It does include diagnosis and procedure codes
    • Bulk of clinical data will be in attachments
  • Provider needs a chance to review what data will be sent to payer, and can confirm that it's minimum necessary
    • Logic in the provider system should address the minimum necessary
  • Need a set of guiding principles for what constitues an appropriate request and an appropriate response
    • Work is underway, will bring it back to this group within a month or so
    • Most of the issue is going to be in DTR because that's what's collecting the data
  • If payer is requesting data, that happens via DTR
    • Could fully implement PAS without implementing DTR as a pre-requisite
  • Any implementation shall allow a provider to review what's being sent, but it's not required
  • Need to include a statement re: glidepath to addressing this issue with technology?
    • This IG isn't collecting the information - should be addressed where it's actionable in DTR
  • Persuasive with mod - Kathleen is comfortable with wording

#24196

  • Provider sends 278, payer provides Prior Auth ID# - care team member involved can go back with same ID and see an updated response when they shouldn't if they are no longer part of care team
    • Attestation needed?
    • What authentication/authorization occurs on payer side? Applies to FHIR and X12
    • Can't specify what X12 is going to do in this IG
    • Document the security risk involved and the fact that this is a security consideration that needs to be addressed during implementation
      • Give examples of how implementers could address - e.g., attestation via portal, use security labels to indicate user is a member of the care team, etc.
    • Is it mandatory to go the x12 route to get the status?

      • No, but there will be some architectures where it will go through X12 so our proposed solutions should ideally work that way
      • X12 does have a security wrapper standard we could review


Next agenda

Ballot comment review continued


 Adjournment

 Adjourned at 4:02pm ET


Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Connectathon Kick-Off Presentation and recording
Prior Authorization Support Draft Implementation Guidehttp://build.fhir.org/ig/HL7/davinci-pas/index.html


Tasks

  •