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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
  •  

  •  
CassieBCBS FL

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
  •  
Cynthia GinsburgCMS
  •  
Eshaa DhalleClinicalWorks


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

Ballot Comment Review
  • 9 typos, 2 publishing related issues
  • A couple of unclear items, need more input from original commenters
  • Subset of comments already have proposed resolutions to be included in a block vote
  • Remaining items will be reviewed on this call weekly

#24770

  • Given that information is coming from a payer, they may not have it in clinical form - language in the IG seemed to make the assumption that it would always be in the format/coding that clinicians typically use, and we should respect the nature of information that payers have
    • Language is intended to sync up when it comes to describing the active treatment - depends upon which component of the bundle we're talking about
    • Transitions in Care use case - patient moving from hospital to assisted living facility - maintaining alignment across use cases might be useful
    • Patient could be a stakeholder of this document - they have the right to request it
    • ONC mention - transitions in care exchanges have required content that gets exchanged between providers
      • We're using the same fields that the federal rules require (including treatment plan, goals - aligned with care plan)
      • Requirement is to support the ability to send whatever information you have
      • In support of anticipated CMS final rule - this statement is already included elsewhere in the IG
    • Julia Skapikwill work on verbiage and bring back to the group for review

#24781

  • Payer business is done in ICD-10, and provider business done in SNOMED
    • Payers are not equipped to do translation between the two
    • We're pointing to US Core, which requires SNOMED (payers could also send ICD along with it)
    • Payer COULD accept SNOMED if it's sent to them and could pass that along
    • Payers CAN'T accept a SNOMED, convert it to ICD, and then convert it back to SNOMED to send to a secondary provider
    • Payer concern re: sending wrong translation will prevent them from doing this at all
  • Could create our own HRex Profile to pass ICD, instead of pointing to US Core
    • Some clinical systems use/store ICD-10 and do a translation when they need to send a SNOMED code
    • Use a dummy code for SNOMED and refer to ICD instead? Not recommended
      • Could send a more general SNOMED (e.g., 'problem')
      • US Core needs to be aware of the business problem that exists
  • 2 Options:
    1. Create a parallel set of profiles to US Core and constrain the vocabulary differently so that you can use SNOMED or ICD-10, and we wouldn't care which (not preferred)
    2. Could add an extension that says this is a translated code and is not source of truth - set expectation that if you are translating ICD-10 into SNOMED, you also need to send the ICD-10
  • Purpose is different in paying a claim vs. patient care
  • Lloyd McKenziewill raise this on US Core Zulip stream to get more input
  • Need input from CMS re: willingness to do translation table
  • Mary Kay chat: SNOMED CT to ICD-10-CM Map: https://www.nlm.nih.gov/research/umls/mapping_projects/snomedct_to_icd10cm.html

#24779

  • Should make it clear that prior claims may be exchanged in their original formats
    • Expectation is that relevant claims information will be exposed as appropriate FHIR clinical resources - not necessarily exchanging the claim itself/claim format, though nothing prohibits that
    • Comment was aiming to give payers flexibility - if they can't convert the info, they could send what they have
    • Payers sharing 837 data is done now for coordination of benefits
      • In Medicaid world, when patient changes health plans claims data is sent to new health plan
    • Need to come back to this one next week

Julia Skapik will work with Robert Dieterle to figure out best approach for getting more external input on these issues






ManagementNext agenda

Ballot comment review


 Adjournment

Adjourned at 3:01pm ET


Supporting Documents


Action items


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