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Chair: Mark Scrimshire

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
  •  
Sequoia
  •  
InterSystems
  •  
BCBS IL
  •  
Allscripts
  •  
Cambia Health
  •  
Enablecare
  •  
David DodgeCambia Health
  •  
Rachel Foerster & Associates
  •  
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
  •  
Diameter Health
  •  
Cambia
  •  
NewWave
  •  
Edifecs
  •  

  •  

  •  
YuriyHealthLX
  •  
Stephen MacVicarMITRE
  •  
Anna MeisheidCMS
  •  
Epic
  •  
Paul Knapp
  •  
Dave FosterEdifecs
  •  
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
  •  
Zach Heath
  •  
Centene
  •  
Veradigm
  •  
Kenneth Foster
  •  
Cigna
  •  
Christopher StehnoCorepoint Health
  •  

Neena Dakua


  •  
MD Partners
  •  
Joe Miller
  •  
Gevity
  •  
Thomas GrannanAzuba
  •  
Mike SabinMedica
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
  •  

  •  
May TerryMITRE
  •  
Rutika
  •  
Ashley H. MaplesExpress Scripts
  •  
Brody BrodockAllscripts
  •  
Michael BrodyCME Online
  •  
Theressa BaumannBCBS AL
  •  
Mona ChandrapaleClinicalWorks
  •  
Optum
  •  
Aakash DeliwalaeClinicalWorks
  •  
Mayo
  •  
Eddy Hernandez-NievesEpic
  •  
Shaheer
  •  
Stanley Nachimson
  •  
Anthony SmithUNC Health
  •  
Howard Cohen
  •  
Minaei BehnazFDA
  •  
BCBSA
  •  
Shilesh Nairgdit
  •  
NewWave
  •  
MaxMD
  •  
BC Idaho
  •  
Edward CastagnaAltarum
  •  
Andrea KentCoverMyMeds
  •  
Carrie Denny
  •  
Kim Pham
  •  
Celine LefebvreAMA
  •  
Edifecs
  •  
Josh LambUPMC
  •  
Keya ShahCasenet
  •  
Gevity
  •  
MITRE
  •  
Mrugen MehtaeClinicalWorks
  •  
Revathi Jayakumuar
  •  
Supriya
  •  
Bapi Behera
  •  
Matt DyerVyne
  •  
Sree Vijetha VegiC-HIT
  •  
BCBSA
  •  
Rich BlochLumedic
  •  
Cigna
  •  
Matthew Hoesch
  •  
Vijaya ShivgandUPMC
  •  
Lauri ShockArkansas Blue Cross Blue Shield
  •  
Zanub MalikUPMC

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



Virtual Connectathon

2020-05 Connectathon 24 May 13-15, 2020

PDEx: 2020-05 Da Vinci - Payer Data Exchange (PDex) Track

PDEx Directory: 2020-05 DaVinci PDex Plan-Net

PDEx Formulary: 2020-05 DaVinci PDex Drug Formulary


  • PDex Track
    • Need to test payer to payer member query when member is not making the connection to the old health plan - need to add this to IG
    • Will we be testing EHR side as well for this upcoming Connectathon?
      • We covered SMART on FHIR and CDS Hooks scenarios in previous Connectathons
      • If folks are interested in testing provider to payer interaction, we can include that
      • Reach out to Mark Scrimshire if interested
  • PDex Directory Track
    • Hope to have an updated IG based on ballot reconciliation and updated Reference Implementation for Connectathon

Input needed - proposing that we test the following options at the Connectathon:

  • If you have to do something asynchronously (e.g., PCDE - to ask for summary of current treatment and supporting documentation), have created a process for identifying the patient/member.  How do you let the requestor know that it's complete?
    • Option 1: Payer pushes to requesting payer
    • Option 2: Payer polls to determine if it's done
    • Option 3: Monitor progress using a Task - when task is complete, you could query for it
    • Option 4: Use subscription (R4 version) - when you've completed the task, send a notification to the requesitng payer's endpoint
      • Notifiation could exclude PHI - just include an ID number
  • Should we add the above into the existing Connectathon tracks?  Team to work with Sandy Vance


PDex Provider Directory Ballot Comment Review

PDEX-Plannet-0403_v2.pptx

  • Practitioner.extension.accessibility
    • Practitioner doesn't have wheel chair access or handle cognitive issues
    • Proposing we remove extension from practitioner and keep it in location 
    • Participants ok with proposed approach
  • Practitioner.extension.communication-proficiency
    • Use as is or change binding to required?
  • Dropping MS requirements
    • Group is ok with the proposed approach to remove must support requirements from the elements listed in the presentation reviewed (PDEX-Plannet-0403_v2.pptx)
  • Endpoint.endpoint-usecase extension


Any outstanding PDex issues
  • Applying Block Vote 3 changes to the IG
  • Planning to push updated IG out on Monday (4/6)


Update re: HL7 Financial Management/ PPIE workgroups
  • In process of working through final issues related to CARIN Consumer-Directed Exchange IG and thinking through what is included in final rule from CMS, there are a few areas identified that need further work: 
    1. Making sure we understand how we deal with subscriber/member
    2. How do you deal with coinsurance or multiple coverages (PPIE workgroup)
    3. Dealing with code systems/value sets issues - administrative and clinical sets (e.g., licensing, availability for use, etc.) (FM workgroup)
    4. Search criteria - set established by CARIN and a set established inherent in US Core and recently adopted by Da Vinci IGs - do we need to harmonize or can they be different?
    5. Authentication/Authorization - when you have more than one individual associated with a particular contract - subscriber and members - what do you do when you have someone other than the person who's on the contract who needs access to information (e.g., acting as proxy, etc.) (FM workgroup, Security workgroup)
  • Technical oriented issues will be discussed in FM workgroup
  • Business oriented issues will be discussed in PPIE workgroup
  • Provenance - Bob has mapped out a path forward to handle on PDEx


Next Agenda
  • Review feedback on updated PDex IG

 Adjournment

Adjourned at 12:51pm ET


Outline Reference

Supporting Document

Minute Approval
Meeting Presentation (4/3)PDEX-Plannet-0403_v2.pptx
PDex Companion GuidesPDex IG Companion Guide List





Action items