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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
  •  
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


  •  
Centene

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
  •  
Ronald MacDurmon


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



Ballot Comment Review
  • 17 issues left to review

#24776

  • Some discussion has taken place on the Implementer channel (chat.fhir.org)
  • 2 different types of authorizaiton
    • Authorization to post the CommunicationRequest
    • Authorization to extract relevant information and provide access to whomever is asking
  • Defer until a later call to see if further discussion solidifies approach

#24777

  • CMS NPRM implies that an individual/member of a prior plan can tell the prior plan to send the data to X Payer
    • Implied ability to authorize an old plan to send to a new plan
    • Member needs to authorize a payer application
  • If Payer B asks Payer A with authorization token from patient, or asking without an authorization token, or patient asks Payer A with an authorization token - it's always a solicited request
  • Need an additional diagram showing flow where patient is not authenticating to the new plan at all, and only authenticating to the old plan, and submitting the request to them
  • To make this work, plans involved will register their applications with each other and the endpoints will be known (Medicare Advantage, Medicaid, QHP, CHIP, etc.)
  • Is there a situation where a patient can't authenticate themselves to a new plan and only can authenticate themselves to the old plan?
    • Maybe in the beginning? Could be a timing issue (e.g., patient enrolls for Jan 1, 2020, but the patient coverage hasn't started yet)

#24781

  • Based on changes to US Core, this only remains true for Medications - expectation that NDC codes or HCPCS codes will be translated into RxNorm 
    • RxNorm is publicly available, but in some cases transforms need a license (though in this scenario, probably not)
  • Regarding prior authorizations, should send back per Prior Authorization Support IG

#24782

  • Robert Dieterle to convene a group to discuss what valueset and binding strength is appropriate for action.code and action.reasonCode

#24785

  • This is a CDex profile
  • Coverage should be included (required or optional?) as a CommunicationRequest.about
  • Transfer this item to CDex for resolution

ManagementNext agendaBallot comment reviewed
 Adjournment

Adjourned at 3pm ET


Supporting Documents


Action items


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