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Chair:  Robert Dieterle

Scribe: Dana Marcelonis

 

Attendees

Present

Name

Affiliation

  •  
SureScripts
  •  
Regence
  •  
Optum
  •  
Michael BaillieUHC
  •  
Humana
  •  
BCBS AL
  •  
Rush
  •  
SureScripts
  •  
Rush
  •  
Cerner
  •  
Laurie BurckhardtWPS Health Solutions
  •  
Lindee ChinEdifecs
  •  
Independence Blue Cross
  •  
Allscripts
  •  
Regence
  •  
Didi DavisSequioa
  •  
InterSystems
  •  
BCBS IL
  •  
Allscripts
  •  
Cambia Health
  •  
Enable Care
  •  
David DodgeCambia Health
  •  
CAQH Core
  •  
Howard FollisJuxly
  •  
Reliant Medical Group
  •  
Lantana Consulting
  •  
SureScripts
  •  

  •  
Independence Blue Cross
  •  
GunjitZeOmega
  •  
Kenneth Hall
  •  
NCQA
  •  
Optum
  •  
Jackie HardisonHumana
  •  
Cigna
  •  
HealthLX
  •  
ZeOmega
  •  
BCBSA
  •  
Point of Care Partners
  •  
Edifecs
  •  
Heather KennedyBCBST
  •  
Edifecs
  •  
Sathaya KrishnasamyAnthem
  •  
BCBS AL
  •  
Stephen LaneSutter Health
  •  
InterSystems
  •  
Anthem
  •  
Luis MaasEMR Direct
  •  
Erin MajderBCBS IL
  •  
Point of Care Partners
  •  
Cognosante
  •  
BCBS AL
  •  
Lloyd McKenzieGevity
  •  
Optum
  •  
Humana
  •  
MaxMD
  •  
Stratametrics
  •  
Sean ParsonsBCBS OK
  •  
Scott Parsons
  •  
BCBS AL
  •  
Allscripts
  •  
HealthLx
  •  
Optum
  •  
Optum
  •  
Regence
  •  
InterSystems
  •  
NewWave
  •  
NewWave
  •  
ZeOmega
  •  
Anne Marie SmithNCQA
  •  
InterSystems
  •  
UHC
  •  
Casenet
  •  
Cigna
  •  
HealthLX
  •  
Independence Blue Cross
  •  
Joel WalkerHealthLX
  •  
Holly WeeksRegence
  •  
BCBS AL
  •  
Darrell Woelk
  •  
Cambia
  •  
Brent Woodman
  •  
Anthem
  •  
Cambia
  •  
NewWave
  •  
Edifecs
  •  

  •  

  •  
YuriyHealthLX
  •  
Stephen MacVicarMITRE
  •  
Anna MeisheidCMS
  •  
Epic
  •  
Paul Knapp
  •  
Dave Foster
  •  
John FeloExpress Scripts
  •  
Ken Lord
  •  
Roland GamacheAHRQ
  •  
Epic
  •  
Jennifer Joe
  •  
Stephen McVicarMitre
  •  
Joe HamiltonUnity Point
  •  
Matthew FloresAdvent Advisory Group
  •  
Providence
  •  

  •  
EMR Direct
  •  
Barbara WoodPNC
  •  
Eshaa DhalleClinicalWorks
  •  
Katherine RuizUNC Health
PresentNameAffiliation
  •  
Tibco
  •  
Aim Specialty Health
  •  
Christy Dodson
  •  
BCBSM
  •  
Allscripts
  •  
BCBSFL
  •  
BCBSM
  •  
CMS
  •  
Mike HurleyBRYJ Healthcare
  •  

  •  
Tori WillowsWellcare
  •  

  •  
Nandini GangulyEMDI - Scope Info Tech
  •  
Moxe Health
  •  
Jim McKinleyMedicaid Alabama
  •  
BCBST
  •  
Bart CarlsonAzuba
  •  
Deepthi ReddyMettle Solutions
  •  
Allscripts
  •  
Eric SullivanInovalon
  •  
David Hill Mitre
  •  
Pallavi TalekarScope Info Tech
  •  
Ralph Saint-PhardHealow
  •  
Scott SwihartSumma Health
  •  
India DuncanOptum
  •  
Jason CassidyMoxe Health
  •  
Praveer MathurWellcare
  •  
Megan Soccorso

Cigna

  •  
Prashanth GolcandaLumeris
  •  
Rajesh Godavarthi
  •  
Availity
  •  
Susan LestinaAHA
  •  
Bob BowmanCAQH
  •  
Thomas KesslerCMS
  •  
Patrick Edwards
  •  
Briana BarnesScope Info Tech
  •  
Kishore MetlaMettle Solutions
  •  
John DonnellyInterpro
  •  
Lorraine DooCMS
  •  
Melanie JonesCMS
  •  
Rim Cothren
  •  
Yolanda VillanovaCMS
  •  
Kathleen Connor
  •  
Manoj KumarBCBSFL
  •  
Saul KravitzMitre
  •  
Srinivas KonchadaCentene Corporation
  •  
Sheryl TurneyAnthem
  •  
Helina Gebremariam
  •  
Mike NovalesBCBSIL
  •  
Ric LightHumana
  •  
Ann GallagherOptum
  •  
Chris KlesgesMitre
  •  
Adam GronskyHealth Fidelity
  •  
CaseNet
  •  
Anthem
  •  
CMS
  •  
eClinicalWorks
  •  
Healow
  •  
Interfaceware
  •  
Mark RucciSpectramedix
  •  
Carie HammondAEGIS
  •  
Anthem
  •  
Cindy MonarchBCBSM
  •  
ONC
  •  
Dawn PerreaultBCBSM
  •  
Kyle ZumsteinAvaility
  •  
Nancy SpectorAMA
  •  
Bruce WilkinsonBenmedica
  •  
Cara BarryAvality
  •  

Chris Johnson

BCBSAL
  •  
Duane WalkerBCBSM
  •  

  •  
Greg LindenLinden Tech Advisors
  •  
Mario JarrinChange Healthcare
  •  
Megan Smith-HallingsheadRegence
  •  
Patrice KuppeSurescripts
  •  

  •  
MCG
  •  
ONC
  •  
Surescripts
  •  
NCPDP
  •  
Anupam ThakurBCBSFL
  •  
Jonathan HutchinsBCBST
  •  
Anthem
  •  
Sunitha Godavarthi
  •  
Christopher GraconIndependent Health
  •  
Labcorp
  •  

  •  
James DerricksonIntersystems
  •  
Douglas DeShazoCognizant
  •  
Neetha JosephCognizant
  •  

  •  
Terry MayMitre
  •  
Rutika
  •  
Ashley H. MaplesExpress Scripts
  •  
Brody BrodockAllscripts
  •  
Michael BrodyCME Online
  •  
Theressa BaumannBCBS AL
  •  
Mona ChandrapaleClinicalWorks
  •  
Optum
  •  
Aakash DeliwalaeClinicalWorks
  •  
Mayo

Create Decision from template

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



Connectathon Links

Links to PDex FHIR Guides and Code

PDex IG:  http://build.fhir.org/ig/HL7/davinci-epdx
PDex Plan-Net IG: https://build.fhir.org/ig/HL7/davinci-pdex-plan-net/index.html
PDex Formulary IG: http://build.fhir.org/ig/HL7/davinci-pdex-formulary
 

The Github repositories:
PDex IG: https://github.com/HL7/davinci-epdx
PDex Plan-Net IG: https://github.com/HL7/davinci-pdex-plan-net
PDex Formulary IG: https://github.com/HL7/davinci-pdex-formulary

The connection between Trifolia and the Github repositories is a manual push.

However the web hooks are in place to publish from GitHub to build.fhir.org automatically. The Continuous Integration Builds for the guides are here:

PDex IG: http://build.fhir.org/ig/HL7/davinci-epdx/
PDex Plan-Net IG: http://build.fhir.org/ig/HL7/davinci-pdex-plan-net/
PDex Formulary IG: http://build.fhir.org/ig/HL7/davinci-pdex-formulary/

PDex IG Companion Guide - Laboratory Reporting Resources



PDex Formulary Ballot Reconciliation/ IG Updates

Balloted Formulary IG: http://hl7.org/fhir/us/Davinci-drug-formulary/Jun2019

  • Met with Pharmacy workgroup this week to review outstanding dispositions on the ballot comments
  • MITRE is going to apply those changes to the Implementation Guide
  • Will produce spreadsheet of ballot comments, resolutions, and update IG in the next 2 weeks for folks to review
  • After 


PDex Directory IG Update

Directory IG: http://build.fhir.org/ig/HL7/davinci-pdex-plan-net/

  • Financial Management workgroup - Notice of Intent to Ballot this week
  • Next week, Saul will attend and review Implementation Guide with the workgroup
  • Dave/Stephen also working on Server and Client Reference Implementations
  • Monday, Oct 7th review session with Financial Management
    • Bring people up to speed on FHIR resources, profiles, IGs
  • MITRE will do a detailed review of the Directory IG on Tuesday, Oct 8th 
    • Committee will have a week to review and raise any issues
  • Financial Management workgroup vote expected on Oct 14th to approve IG to go to ballot


PDex Ballot Comment Review

#23222

  • Subscriber ID is used as if it's the unique ID for the patient/beneficiary - this is misleading
  • Suggest in the intro, identify what the Member ID is, that not everyone has one, and what the Subscriber ID is
  • Be careful as to when referring to each one
  • Perasuasive with mod
  • This should be applicable to all Da Vinci IGs

#23226

  • Refer to resolution on #23222
  • Persuasive with mod

#23232

  • Intent was not to support STU3 or DSTU2 in this IG
  • Intent is to only support R4
  • In light of changes we're making to CRD and DTR, we're ok
  • Not persuasive

#23240

  • Clarify that "health plan API" refers to an implementation of this specification
  • Not persuasive with mod

#23250

  • We don't have NULL flavors in FHIR
  • IGs need to indicate what they mean by MUST SUPPORT 
    • Call out those circumstances, so that if it's optional, as in 0.. they only need to fill it in if they have it
    • If it's 1 or higher.. it must be supplied, but if they don't have it they can insert a data missing reason
    • There are circumstances where you're not allowed to insert a data missing reason - no easy way to specify that - probably with an invariant
    • Data missing reason should only be used if it's valuable
    • Is this a situation where we care about/take business action based on the reason, or are we just trying to get around the cardinality problem
  • If a field is marked as required (cardinality n.. when n>0) the health plan SHALL populate the field
  • If a field is marked MUST SUPPORT and cardinality is 0.., the health plan SHALL be capable of populating the field when relevant data exists
    • In order to convey the message, if you don't give me the business data required for this element, I will reject? Cardinality of 1...
    • Cardinality of 1.. value has to be sent, and it has to be valid
  • No standard place to point to for MUST SUPPORT, so each IG needs to define
  • If field is MUST SUPPORT, receiver must be able to consume it without generating an error
  • Persuasive with mod

#23252

  • Mark comment as withdrawn

#23254

  • IG appeared to indicate the Member ID would be in the patient.identifier - this falls apart once someone has multiple coverages
  • Member ID should be in the coverage.identifier
  • Persuasive

#23260

  • Date of Service is typically the date that it was completed, not a period (start and end date)
  • If creating an Encounter resource from a Claim, this is the best mapping available
  • In case of Claim, would set start and end date to be the same date
  • In case of Encounter, it's also a period (start and end date)
  • Need to have payers provide input
    • What do we want to populate for Period in an Encounter resource based on a Claim? Probably depends on the type of claim
    • If the Claim has a Period, populate period
    • If the Claim only has a single date of service, then populate start and end date of the period with the same date
  • Persuasive with Mod





 Adjournment

Adjourned at 1:04pm ET


Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Connectathon Kick Off Presentation

Connectathon Presentation.pptx and recording

PDex Companion GuidesPDex IG Companion Guide List





Action items

  •