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Chair:  Robert DieterleMay Terry

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 GouldBCBSA
  •  
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 Hernandez-NievesEpic
  •  
Christopher Gracon


  •  
Centene
  •  
Andrea KentCoverMyMeds
  •  
BC Idaho
  •  
Keya ShahCasenet
  •  
Neena Dakua
  •  
Michelle BarryAvaility
  •  
NCPDP
  •  
Shane Mull
  •  
MITRE
  •  
Court
  •  
Ed Sanchez
  •  
Judy Williamson
  •  
Melissa KirchenbauerCGS Admin
  •  
Thomas GrannanAzuba
  •  
UNC Health
  •  

  •  
Guidewell
  •  
John Whittington
  •  

  •  
Jason RhodesPalmetto
  •  
Karen Zajicek
  •  
Kelli Miller
  •  
Michael BrodyCME Online
  •  
Sonya MayOptum
  •  
Michael FasuloRegence

Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  
Rachel Foerster & Associates
  •  
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
  •  
Joseph MinieriMITRE
  •  
Dave Foster
  •  
Providence
  •  
Betty SullivanAllscripts
  •  

  •  
June Bronnert
  •  
Cynthia GinsburgCMS
  •  
Eshaa DhalleClinicalWorks
  •  
Ronald MacDurmon
  •  
Cigna
  •  
Edifecs
  •  
Cigna
  •  
Mona ChandrapaleClinicalWorks
  •  
Sonja ZieglerOptum
  •  
Celine LefebvreAMA 
  •  
 Ben Largley
  •  
Dawn PerraeultBMBSMI 
  •  
Emily TenEyck CAQH
  •  
Joe QuinnOptum 
  •  
Lindee Chin Edifects 
  •  
Lorraine Doo CMS 
  •  
Padame Metal Solutions 
  •  
Rajesh g
  •  
Josh Lamb
  •  
Edifecs
  •  
Sreekanth
  •  
Bapi Bahera
  •  
Charlie Genova
  •  
Gregg JohnsonPalmetto GBA
  •  
MITRE
  •  
Robin FreePalmetto GBA
  •  
Thomas KehoePalmetto GBA
  •  
Toni WheelerCGS Admin
  •  
Mrguen MehtaeClinicalWorks
  •  
David Lowry
  •  
Alex DelagePalmetto GBA
  •  
Roc ViaCGS Admin
  •  
Craig FranklinCGS Admin
  •  
Hal Bowles
  •  
Harry Feliciano, MDPalmetto
  •  
Mrugen Mehta
  •  
AEGIS
  •  
Kevin DayEdifecs


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



Further explore representation of medical supplies

  • Coverage Transition Bundle
    • Focus on active treatments - meds, therapies, equipment, etc.
    • From FHIR perspective, care plan activity within each one of the care plans would just have medications in one, therapies in another, service requests in another, device requests in another
  • What happens in case where you need to provide various different components supporting essential medical supplies that would be used in an active treatment - not necessarily all devices and all meds, but equipment used in support
    • Splits in treatment kits, e.g.: Oxygen and glucometer
    • One suggestion from last week's call: if glucometer had lancets and reagent strips - FHIR device request resource and then could have devices - device could also reference other devices in hierarchical way
    • Might be relevant to have a request group - device request, request group would have grouping of 3 device requests (i.e., device request for lancets, device request for reagent strips, device request for glucometer)
      • Request group is used when individual requests don't have individual statuses (e.g., can't cancel one without canceling all)
      • Suggestion would be to just have 3 device requests
  • Home Oxygen Therapy Determination
    • Future requirement to pass lifetime and intermediate 'counters' from payer to payer? (e.g., initial 36 months, 37-60 months, 60+ months)
      • 'Counters' would be observations?
      • Ideal representation of hysterectomy is that the procedure happened - after the fact, if capturing medical history could be captured as Observations or Procedures
    • Could this transaction be a service request for the provision of oxygen therapy equipment?
    • Who decides that patient gets a new tank or a refill on an old tank? Initial order has to be written by an MD
      • Prior authorization or claim would have who wrote the order
      • When oxygen tank is empty, new one comes in - the payer will have initial request, order that came in/authorization for rental/certifiate of medical necessity
        • If there's a change in supplier, there may be a new certification that needs to happen
      • Payer would know from claim system or prior auth system; DME supplier could change
    • New payer asking old payer - dispenses are better if they have them
    • Focus on initial order for now

ManagementNext agenda



 Adjournment

Adjourned at 2:50pm ET


Supporting Documents


Action items


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