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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
  •  
Bart CarlsonAzuba

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
  •  
Zachary Fjeldheim


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



Updated PCDE client demo

Updates

  •  Medication
    • Based on previous discussion, determined that MedicationRequest by itself wasn't sufficient - MedicationDispense should also be included where it could be
    • These are grouped - RI UI is reading resource type and regrouping
  • Supporting Information
    • Supporting documents can be downloaded (e.g., Certificate of Medical Necessity)


  • Still ok to leave Oxygen in the Medication?  Or does it make more sense to have a grouping?
    • Oxygen regulator would be under Devices
    • Whenever grouping is possible, probably more user-friendly, but might not be possible to do this for every single thing
  • Document reference can prompt health plan to reach out in a separate call to retrieve each document reference
  • New health plan could anticipate very large attachments and be prepared to handle that?
    • Example was ~4MB - 3 embedded PDFs, one was 5 pages long
    • Not unreasonable to expect 100MB - several hundred MB
    • Should we put something in the IG to this effect?
    • There's no way to know how large
    • If we have a limit, then would have to break things into pieces, but then have to add a piece management protocol
    • Still want everything in one bundle


Draft supplemental guide/examples in Confluence

PCDE Supplemental Guide

Payer Coverage Decision Exchange Use Cases


  • If the protocol changes (e.g., Regimen ID: BR589), does that automatically get updated?
    • IDs would have a version
  • Medication
    • There would be a MedicationRequest under that care plan but there would salso be a MedicationDispense
      • Decided to put dispense under activity outcome reference
    • Unless there's a prior auth request for brand name, the payer wouldn't know if there was a substitution (e.g., if PBM did a generic substitution, payer might not ever know that





ManagementNext agenda

Revisit disposable medical supplies representation in PCDE bundle

Revisit scenario with no active order


 Adjournment

Adjourned at 3:01pm ET


Supporting Documents


Action items


Create Decision from template