Page tree
Skip to end of metadata
Go to start of metadata

Chair:  Dr.Nita Thingalayaand Dr. Julia Skapik

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

  •  
Robert DieterleEnablecare
  •  
Stratametrics
  •  
Nita ThingalayaIBC
  •  
Cambia Health Solutions
  •  
Gregory MagazuCaseNet
  •  
Jeanie SmithBCBSFL
  •  
Corey SpearsInfor
  •  
Optum
  •  
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
  •  
BCBSAL
  •  
Tracey McCutcheonKPMG
  •  
Dawn PerreaultBCBSM
  •  
CMS
  •  
Anupam ThakurBCBS FL
  •  
Anthem
  •  
Allscripts
  •  
BCBSM
  •  
Chris JohnsonBCBSAL
  •  
MITRE
  •  
ZeOmega
  •  

  •  

  •  
Cigna
  •  
eClinicalWorks
  •  
Tibco
  •  
Eddy NievesEpic
  •  
Christopher Gracon

Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  
CAQH
  •  
Pallavi TalekarScope Info Tech
  •  
Kelly TaylorCMS
  •  
Karen L. ZapataAnthem
  •  
Brandon RaabAnthem
  •  
Cindy MonarchBCBSM
  •  
Michael CabralCMS
  •  
Nick RadovUHC
  •  
Epic
  •  
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 MinieriMITRE
  •  
Dave Foster
  •  
Providence
  •  
Betty SullivanAllscripts
  •  

  •  
June Bronnert
  •  
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



Block Vote Scheduled for Next Week
  • Financial Management workgroup meeting - Tuesday, Oct 22nd at 11am ET
  • Block vote 1 - 30 items
  • Insert link to review:  


Feedback needed re: Identifiers - planning to schedule a call
  • Need input from payers re: Member Identifiers and Health Plan Identifiers
  • Please send email to May Terryor Robert Dieterle if you'd like to be involved


Update on terminology discussions


Ballot comment review

24758

24760

24761

24762

24766

24768

24770

24791


#24793

  • "current care" - only send information re: active treatment

#24758

  • Do payers have coded goals?
    • Medicare Advantage plans would use same goals as in the STARS ratings - the ratings themselves are identified by code numbers, and the content of the quality measures are based on CPT, ICD-10, LOINC, etc.
  • Coded goals should be sent if available, though payers are not likely to have coded goals outside of case management or quality measures

#24760

  • Business treatment and operations are considered relevant to this IG
  • HIPAA and 42 CFR Part 2 apply to this IG

#24761 - Needs follow up after Identifiers call takes place

  • Should payer organization be identified by NAIC code?
    • Defer discussion on this item until call re: health plan and member identity
  • Would a payer have a single API address to reference?
    • Likely payers will have multiple FHIR endpoints, particularly in the case of acquisitions
    • In acquisitions, retaining the identifier of the organization acquired? Depends
    • Production vs. stage vs. test endpoints will likely exist
    • If using an intermediary, there's only one endpoint that will route appropriately
  • Endpoint is different than identifier for organization
  • How to identify endpoint if more than one exists, is not within scope of this IG
  • Payers would need to identify the endpoint to be used with their trading partners

#24762

  • Julia cleaned up the proposed language

#24766

  • Requirement will apply to plans cited in the CMS final interoperability rule (link will be added to IG when available)

#24767

  • Change to: "...provider directory and other member related health information"

#24768

  • AMA comment in Prior Auth Support re: changing "medically necessary" to "medically appropriate"
  • Remove last portion of phrase referring to appropriate therapies or medically necessary

#24770

  • Group ok with proposed language

#24791

  • This item has a note that refers to #24756, but it doesn't cover the whole issue
  • Change 'current care' to 'active treatments'
  • Intent is to include all active treatments

#24778

#24780

  • Additional Note section - exchange needs to include Coverage resource to accurately identify the health plan, the member, and the subscriber for both the sending plan and the receiving plan


For next week:

24776

24779

Re: CommunicationRequest approach: 24787,24788



ManagementNext agendaBallot comment review
 Adjournment

Adjourned at 3pm ET


Supporting Documents


Action items


Create Decision from template