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

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
  •  
Clay Rogers
  •  
Thomas GrannanAzuba
  •  
Matthew Hoesch
  •  
Vijaya ShivgandUPMC
  •  
Lauri ShockArkansas Blue Cross Blue Shield
  •  
Zanub MalikUPMC
  •  
Vishnu
  •  
Erin GosneyHumana
  •  
Summer DumanRegence
  •  
Sonya MayOptum
  •  
MITRE
  •  
POCP
  •  
MA Health Data
  •  

  •  

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
  •  
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
  •  
Avality
  •  

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
  •  
Michael Kim

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



HL7 Virtual Connectathon 

HL7 Virtual Connectathon - May 13-15

PDex Connectathon Track Briefing: PDexConnectationPrep.pptx



PDex

$payer-match is now $member-match

Latest Build: https://build.fhir.org/ig/HL7/davinci-epdx/ 

  • HL7 Da Vinci PDex $member-match
  • Uses Parameters Resource to submit content
  • If this is batched, do you need bundle as wrapper when you return it?
    • If you pass in a bunch that says run this operation on this, etc.
    • Response will also be a batch with the response from each operation as an entry
    • If you invoke operation once, what do you expect to get back?
    • If operation is set up that you can pass in information re: multiple members and get back different results, bundle might make sense
    • But if operation is per patient, bundle doesn't make sense
    • If I return more than one resource and these things go together, doesn't that have to be in a bundle?
      • No, you can return a Parameters resource, which contains the items
    • Request for match contains 3 things, and returning 3 things
    • During enrollment, payers may have thousands of these, can we batch them up?
    • Batch - you have a bundle with a bunch of entries, and each entry has the request
    • Could have a a bundle with a thousand entries, each which has a request and payload
    • Response will be batch response bundle with equal number of entries as request, and each entry will include a response (some might be 404, 200, etc.) - payload of those could be operation outcome (e.g., 404)
      • If 'not found' return operation outcome or is 404 sufficient?
        • Are we treating this as a search where 'not found' is considered to be a success? Could provide operation outcome, but don't necessarily need to
        • Or is it that you did something wrong and we want to tell you why we didn't find anything, in which case spitting back an operation outcome instead of the success with a failure HTTP code is appropriate
    • If batch coming back, can identify via parameter list
    • 1:1 correlation with the request batch - you have to know exactly what you asked in order to correlate the responses to the request - it's positional
      • It's an error if your response bundle doesn't have exactly the same number of responses as the request had number of requests
    • Connectathon focus is on one request at a time
    • In is Parameter and out is also Parameter
  • Coverage.identifier = the old payer's member ID from the patient's insurance card
    • Old plan can indicate which identifier should be used by new plan to request the member's records (e.g., old payer's internal identifier for the patient)
    • Unique identifier isn't for the coverage, it's for the patient - should it go in Patient.identifier instead of Coverage.identifier?
    • When the new payer asks for data from old payer they'd take that identifier and put it in the Patient.identifier anyway
    • It's the old plan saying here's the identifier I have for the most recent coverage, and here's the universal one that goes with it
    • Want to return the patient coverage record because that's where it has the unique member ID to associate back to internal records
    • Within Coverage, Coverage.identifier is where member identifier goes - Coverage.identifier.type
    • Coverage.identifier = member specified as old member ID
    • Patient,identifier = old plan says use this member identifier
    • There might be multiple Patient.identifiers - need a unique Type code to indicate which one is populated by the old plan
    • Probably need to identify what time period that unique identifier is covering?
      • Identifier should provide access to data as far back as they have it
      • Why do we need to include a period?
      • If member switches from one company to another, the member could have multiple member identifiers, but the old plan is providing a unique internal ID that ties all that data together - it's an identifier for the person, not specific to coverage
      • Time period would be helpful to indicate that the patient might have had a different payer for the rest of the timeframe you're looking for (e.g., Old plan B covers 2 years, and Old plan B covers 3 years)
      • CMS rule - previous payer needs to be able to provide data back to 2016
        • As a patient, I don't have to know who payer is?
        • At patient direction, new payer has to go back to old payer - they don't need to figure out all the old payers the patient has ever had
  • Summary
    • Recommendation is to put the identifier in Patient instead of Coverage
    • Team needs to create a picture of this to accompany text explanation
    • Use case descriptions to go along with bundle examples would be helpful


Provider Directory 
  • ValueSet Decisions
    • HealthcareSevice.specialty - NUCC minus 2 codes that don't apply
    • PractitionerRole.specialty - NUCC minus 2 codes that don't apply plus complementary subset for Individual Specialty
    • HealthcareService.qualification.code - NUCC minus 2 codes that don't apply plus complementary subset for Individual Specialty + DLC
  • CodeSystems
    • HealthcareService.category - for directory purposes, consumer-recognizable categories
      • Provider could be a nurse, physician, etc.
      • Codes appear to be interpretable
      • Display values are clear


Next Agenda

 Adjournment

Adjourned at 1:05pm ET


Outline Reference

Supporting Document

Minute Approval
Meeting Presentation 4/10/20
PDex Companion GuidesPDex IG Companion Guide List





Action items

 



2 Comments

  1. I wrote to CMS to get clarification regarding whether payers are required to find payers the patients do not explicitly tell them about and the answer is no. The patient is responsible for notifying their new payer of all previous payers they want transferred.

  2. Thanks Janice Karin, the team was planning to do the same, so perhaps this saved them a step!  Mark Scrimshire