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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
  •  
Unknown User (meryl_bloomrosen)Premier

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
  •  
Celine LefebvreAMA
  •  
Eshaa DhalleClinicalWorks
  •  

  •  
Aakash DeliwalaeClinicalWorks
  •  
Chris JohnsonBCBSAL


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

  • Contained resources are not allowed to have their own tags
  • If you have sensitive information in a contained resource, you need to make the whole resource as sensitive
  • IG doesn't have contained resources as must support
  • Expectation is that resources are independent resources in the bundle, but we don't prohibit the use of contained resources
  • IG background section can point to security checklist
  • The resolution of this issue depends upon how privacy concerns are addressed, so moved to next issue first
  • Kathleen added same comment to other profiles included in IG, so Lloyd McKenzie will mark those issues as duplicates and point back to this one
  • Kathleen Connor is comfortable with proposed disposition

#24194

  • Security considerations section of IG could warn users that they might be receiving protected information and they need to determine how they're going to handle it, even though they might not look at FHIR, and only look at X12
  • Concerned that we're fitting this into 275 and it has some shortcomings, then maybe it shouldn't be used for this
    • Problem exists no matter if content in FHIR or 275
    • 278 exposes information about encounters, procedures, observation information, any which could have security labels on it that constrain what could be done with that information
    • If we ignore 275, the challenge is that we can't mandate that you look at FHIR when you're receiving a 278
    • If you're not looking at FHIR and there are constraints, then need to determine how you'll find out about and follow up on those constraints appropriately
    • X12 278 spec doesn't address whether you share it or not
      • Any additional security would be separate from the 278 (or the 275)
      • We can't mandate security labels re: 278
  • Proposal - security considerations section of IG will add that some of the data that gets shared here may have constraints on its use, if in FHIR, will be represented in security labels - those labels don't get mapped to 275 or 278 - therefore if only looking at 278, it's not going to tell you what those constraints are, so you need to figure them out some other way
    • Call it "Privacy Considerations" instead of "Security Considerations"
    • Kathleen Connor is happy with this proposal
  • This IG doesn't use contained resources, so don't want to include guidance re: contained resources

#24180

  • Privacy & Security Considerations section of IG needs to address HIPAA Minimum Necessary
  • There's no definition of a minimum data set
  • Adding to IGs that implementer shall include, but not require, the provider to review the information prior to it being sent
  • The provider review step addresses one of AMA concerns, but not all of them - Terrence Cunninghamand Robert Dieterlehave been working through them
  • Kathleen Connorproposed that IG should include a statement that we're working on a plan on trying to progress better approaches to determining minimum necessary in an automated way
    • This should go in DTR, and not Prior Auth
    • Kathleen Connor will add a tracker to DTR IG for this issue
  • Terrence Cunninghamquestion re: DTR - 278 is mandated, but if DTR is doing an automated version of this and it's not going through 278
    • DTR doesn't do prior auth at all
    • CRD determines if prior auth is necessary or not
    • DTR allows provider to gather the information necessary to do a prior auth (i.e., supporting clinical documentation/'attachment') - DTR doesn't send anything
      • Handles the assembly of the package but doesn't do anything with the package
    • Prior Auth takes the info from DTR and the info that is needed for the 278 and transmits the package 
  • Notion of improving automated process for assembly - all of the automated assembly lives in DTR
  • As these guides mature, clearer lines of distinction may be needed
    • Block of text that defines the 3 steps that could appear on the top of each IG
    • Terrence Cunningham will submit an issue requesting this

#24192

  • Provider/payers need to determine what's the minimum necessary
  • Suggested wording does not belong in the IG section referenced
    • This section is talking about technically what's in the bundle, not about what should/shouldn't be in the Claim
  • Kathleen Connorwill submit change request for adding security label to the bundle/high watermark, but that's separate from this
  • Not persuasive


Next agenda

Ballot comment review


 Adjournment

Adjourned at 4:03pm 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

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