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Chair:  Larry Decelles

Scribe: Dana Marcelonis


Attendees

Present

Name

Affiliation

  •  
Mitre
  •  
George BierOptum
  •  
BCBS AL
  •  
Rush
  •  
Matthew ByrneOptum
  •  
Rush
  •  
Cerner
  •  
Anthem
  •  
Allscripts
  •  
InterSystems
  •  
Allscripts
  •  
Mitre
  •  
Cambia Health
  •  
Cerner
  •  
Enable Care
  •  
Optum
  •  
Aegis
  •  
BCBS FL
  •  
InterSystems
  •  
Anthem
  •  
Mitre
  •  
Allscripts
  •  
Optum
  •  
Jackie HardisonHumana
  •  
Cigna
  •  
Claudia HartmanHighmark Health
  •  
Mark HinghamAnthem
  •  
Optum
  •  
Sheljina Ibrahim KuttyAnthem
  •  
Allscripts
  •  
Point of Care Partners
  •  
Edifecs
  •  
Mitre
  •  
InterSystems
  •  
Anthem
  •  
Tso LukeOptum
  •  
Point of Care Partners
  •  
Optum
  •  
Cognosante
  •  
Optum
  •  
Humana
  •  
Stratametrics
  •  
Casenet
  •  
Allscripts
  •  
Optum
  •  
Optum
  •  
InterSystems
  •  
C SimeoneOptum
  •  
Jeanie SmithBCBS FL
  •  
InterSystems
  •  
Veradigm
  •  
CMS
  •  
Casenet
  •  
Independence Blue Cross
  •  
Anthem
  •  
CentriHealth
  •  
CaseNet
  •  
India DuncanOptum
  •  
Jason Cassidy
  •  
Optum
  •  
Gevity
  •  
Tracy McCutcheonKPMG
  •  
Rashmi MenonKMHP
  •  
Mario JarrinChange healthcare
  •  

  •  
AMA
  •  
Ann GallagherOptum
  •  
Megan Smith-HallingsheadRegence
  •  
Regence
  •  
Anthony SmithUNC Health
  •  
Optum
  •  

  •  

  •  
Jennifer Joe
  •  
Texas Health
  •  

  •  
Cigna
  •  
Labcorp
  •  
Cigna
  •  
Matt DyerVyne
  •  

  •  
Barbara Kramer-ZarinsMITRE
  •  
Centene
  •  
Barbara WoodPNC
  •  
Greta HoneycuttCoverMyMeds
  •  
BCBSA
  •  

  •  
MITRE
  •  
Keya ShahCasenet
  •  
Rich Bloch
  •  
Interpro
  •  
Lauri Shock
  •  
Andrew JohnsonNational Decision Support
  •  
MITRE
  •  
Mark FlemingChange Healthcare
  •  
eClinicalWorks
  •  
Prathima
  •  
Rachel Foerster & Associates
  •  
Heather McComasAMA
  •  
Megan RileyMITRE
  •  
Summer DumanRegence
  •  
Michelle BarryAvaility
  •  
Chris Cera
  •  
Michael FasuloRegence
  •  
Mettle
  •  
Lauree Marshall
PresentNameAffiliation
  •  
Peter MuirESAC
  •  

  •  
Ryanne LaurenceOHSU
  •  

  •  
Mitre
  •  
CMS
  •  
Aim Specialty Health
  •  
Christy DodsonMCG
  •  
Tibco
  •  

  •  
Rajesh Godavarthi
  •  
Santosh
  •  
Tom Hartman
  •  
Tori WillowsWellcare
  •  
Alise WidmerLumeris
  •  
Bart CarlsonAzuba
  •  
David BruinsmaColonial Med
  •  
Deepthi ReddyMettle Solutions
  •  
Danny BrennanMA Health Data
  •  
Patrick Edwards
  •  

  •  
Cambia Health
  •  
CMS
  •  
Pallavi TalekarScope Info Tech
  •  
Rajesh GarlapatiRush
  •  
Susan BellileAvaility
  •  
BCBST
  •  
Ralph Saint-Phard
  •  
Kristi CushmanOHSU
  •  
Briana BarnesScope Info Tech
  •  
Didi DavisSequoia Project
  •  
Sreekanth PuramMettle Solutions
  •  
Duane WalkerBCBSM
  •  
EMDI Team
  •  
David HillMitre
  •  
BCBS AL
  •  
Nandini GangulyEMDI
  •  

  •  
Rajesh GodavarthiMCG Health
  •  
Rim Cothren
  •  
Donna CampbellBCBSIL
  •  
Joanna GaskillLumeris
  •  
Edifecs
  •  
Michael CabralCMS
  •  
Sudhir NairAnthem
  •  
Saul KaravitzMitre
  •  
Dawn PerreaultBCBSM
  •  
Brent WoodmanBCBSM
  •  
Yolanda VillanovaCMS
  •  
Deryl Lam
  •  
Edifecs
  •  
Karen TottCMS
  •  
MITRE
  •  
Dacarba
  •  
Carradora
  •  
Rachel Goldstein
  •  
Ric LightHumana
  •  
eClinicalWorks
  •  
Healow
  •  
Wanda Govan-JenkinsHHS
  •  
Cindy MonarchBCBSM
  •  
Edward Yurcisin
  •  
Humana
  •  
Hibah QudsiMitre
  •  
Nancy SpectorAMA
  •  
Patrick Leblanc
  •  
Anupam ThakurBCBSFL
  •  
MCG
  •  
Chris KlesgesMitre
  •  
BCBSA
  •  
Gregory MagazuCaseNet
  •  
Isaac VetterEpic
  •  
Kat RuizUNC Health
  •  
Laura Bright
  •  
Humana
  •  
Roland Gamache
  •  
Katherine LuskChildrens
  •  
Anthem
  •  

  •  
Chris JohnsonBCBS AL
  •  
Jim AdamsonArkansas Blue Cross
  •  
Carry Denny
  •  
Infor
  •  

  •  
Anna MeisheidCMS
  •  
Celine LefebvreAMA
  •  
Eshaa DhalleClinicalWorks
  •  
BCBSM
  •  
Express Scripts
  •  
Sandhya
  •  
Christopher GraconIndependent Health
  •  
Candice TitusCrisp Health
  •  
Mariana SinghCAQH
  •  
BC Idaho
  •  
Shilesh NairGdit
  •  

  •  

  •  

  •  
UHC
  •  
Tammy BanksProvidence St. Joseph
  •  
Bob HarringtonAllscripts
  •  
Vishnu
  •  
DanielleSutter Health
  •  
MITRE
  •  
Sonya MayOptum
  •  
Molly MalaveyAMA
  •  
Guidewell
  •  
Angela BublikRegence
  •  
eClinicalWorks
  •  
Advocate Health
  •  
Arsal HussainiAccenture
  •  
Allen Saunders


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Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy




Links

DTR IG: http://hl7.org/fhir/us/davinci-dtr/2019May/

Reference Implementation: https://github.com/HL7-DaVinci/dtr 



Upcoming Call Structure Changes
  • Burden Reduction set of IGs: CRD/DTR/PAS
  • Ballot reconciliation is finishing up
  • Proposed calls:
    1. Implementer Questions re: IGs 
    2. CRD/DTR/PAS Exemplars - representative categories
      1. Examples posted in Confluence, feedback from HL7 community
      2. Post examples in GitHub for developers
    3. Implementation Guide updates for next round of balloting
  • Use existing Wednesday DTR call for questions and exemplars
  • Use Friday PAS call for IG updates moving forward
  • If we need a 3rd call, will re-institute former CRD call
  • Need to rename calls on the HL7 conference call calendar to make call purpose clear:
    • Burden Reduction (CRD/DTR/PAS) Implementer/Supplemental Examples Call
    • Burden Reduction (CRD/DTR/PAS) IG Updates/Future


CRD/DTR/PAS Implementer Questions


How do you associate QuestionnaireResponse with original Questionnaire?

  • Only process QuestionnaireResponse if you have an understanding of the questionnaire
    • DTR use case - Questionnaire coming from payer, and payer knows link IDs for each question
    • No expectation if you share QuestionnaireResponse with other downstream systems that didn't originate questionnaire, that they'll know how to process the data
    • Would need to convert to other resources if want to share with other systems
  • If link ID changed from time sent to EHR system and time it is sent back? (might wait for questionnaire to be completed... perhaps a new question added in interim)
    • Does link ID stay constant? Could provide guidance related to this; version numbers
    • No requirement that link IDs are consecutive
    • Sreekanth Puram to add change request
  • How does this work for PCDE? Assuming QuestionnaireResponse would be part of coverage determination shared from Payer A to Payer B?
    • Bundle that goes to payer would include specific FHIR resources that were originally used to populate the QuestionnaireResponse
    • Questionnaire scenarios:
      • EHR has data and can populate into QuestionnaireResponse
      • Data gaps require provider to populate info into QuestionnaireResponse
        • Subset of data will only be available in QuestionnaireResponse
        • Situations where QuestionnaireResponse will go to a new payer and they won't be able to parse systematically; would require human intervention
        • Add guidance to PCDE to include Questionnaire along with QuestionnaireResponse (SHOULD)
        • Melanie Combs-Dyer to add change request to PCDE


Supplemental Examples - what do we need to develop? (7/1/20 meeting)
  • Need examples for various combinations of orders and determine what's included in current version vs. future:
    • Single
    • Multiples when only one requires a response
    • Multiples when each one requires a response
    • Requires going into DTR or some other process
  • Work with practicing clinicians to develop common high volume scenarios as it relates to DME, Diagnostics, Referrals (e.g., Home Health), Drugs Covered Under Medical Benefit
    • Order set - ordered commonly together, includes multiple orders
    • Multiple orders not grouped together in an order set
    • Orders not within an order set
  • Need examples of discrete reports - whether they be FHIR resource or document reference


Draft list of supplemental examples
  • Scenario where HCPCS codes are same - Respiratory Assist Device (RAD) and CPAP
    • These codes would never go to PAS
    • Would return 2 CARDS and allow user to select DME they want - common diagnosis for both

Potential Examples:

  1. DME – O2
  2. Specialty Med – CodeX is interested in this topic
  3. Diagnostic Imaging – Head MRI, MRA
  4. Lab – Genetic test –
  5. Referral – Occupational Therapy or prosthetics – Example -
  6. Hospital admission - Pneumonia
  7. Home Health Services - eg.g Wound care
  8. Surgery – Arthroplasty (Total hip/knee replacement)
  9. CRD - Types of information/CARDS returned
  10. DTR - collect data and return it directly to payer - what does request look like, how to return it
    • RI demonstrates sending to PAS and sending to another endpoint
    • Extension on Questionnaire re: where response is supposed to be sent?
      • Not currently addressed in IG - Larry Decellesto add tracker to DTR
      • Sending to payer automatically (to same place request came from) in RI
  11. DTR - scenario where Questionnaire not posted directly, but keep it on file via EHR, or include it with prior auth submission or claim submission
    • IG worded like this, but need explicit instruction with respect to the Questionnaire - how do you ask for it and how do you respond
    • Larry Decelles to add to same tracker noted above
  12. DTR - Task workflow
    • Provider orders MRI, provider requirement is to attach Xray but someone else needs to do that - suspend order, send to someone else to complete (attach Xray) and submit - "to do" item put into a queue and/or assigned
    • Once CARD is received, does it matter who works it?
      • Within EMRs, don't yet have process for external agents/orgs (e.g., payers) to inject tasks
      • Task comes back and isn't assigned to anybody (i.e., no expectation that payer would assign it to someone) - whomever creates order has option to assign to someone else's task list, or leave unassigned and some other process defines who picks it up to complete


Homework

Please send Viet Nguyen , Robert Dieterle  or Dana Marcelonis a list of your high priority examples based on volume, complexity, cost, etc. We would like the examples to be useful as well as generalizable for the category of PA. Please email vietnguyen@stratametrics.com


Next Agenda

Future agenda items:

  • Provide overview re: Questionnaire
  • Healow working on examples with Larry/MITRE team and will share with the group

 Adjournment
Adjourned at 12pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval


Action items

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