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Chair:  Robert DieterleViet NguyenAnupam Goel

Scribe:
 

Attendees

Present

Name

Affiliation

  •  
Enablecare
  •  
Stratametrics
  •  
Point of Care Partners
  •  
BCBSAL
  •  

Emily Calvert

CMS
  •  

Erica Ross

CMS
  •  
Heather McComasAMA
  •  
Optum
  •  

Kelly Anderson

BCBSAL
  •  
InterSystems
  •  

Mark Mundt

InterSystems
  •  
Megan SoccorsoCigna
  •  

Mike Funk

Humana
  •  
Nancy SpectorAMA
  •  
Terrence CunninghamAMA
  •  
Tori WillowsWellcare
  •  
BCBSFL
  •  
Aim/ Anthem
  •  

Marci Maisano

Cigna
  •  
Edifecs
  •  
Edifecs
  •  
United Healthcare
  •  
Anthem
  •  
Christy Dodson
  •  
BCBSAL
  •  
Laura Hoffman
  •  
WPS Health Solutions
  •  
Optum
  •  
Edifecs
  •  
CMS
  •  

  •  
CAQH
  •  
Raj
  •  
Ray WilkersonScope Info Tech
  •  
BCBST
  •  
Taha AnjarwallaCAQH
  •  
Tom
  •  
Sonja Ziegler
  •  
Intersystems
  •  
Nandini GangulyEMDI/ Scope Info Tech
  •  
BCBSM
  •  
Kasi
  •  
EMDI Team
  •  
Anthem
  •  
Bart CarlsonAzuba
  •  
Cambia
  •  
Duane WalkerBCBSM
  •  
InterSystems
  •  
Tibco
  •  
Louis BedorCognosante
  •  
Anthem
  •  
CMS
  •  
CMS
  •  
IBC
  •  
Anthem
  •  
Rian
  •  
Palmetto gba
  •  
Sandeep
  •  
Sreekanth PuramMettle Solutions
  •  
Allscripts
  •  
James Gallagher Jr.Premera
  •  
Joseph Figueroa
  •  
Tony LittleOptum
  •  
Pallavi TalekarEMDI/ Scope Info Tech
  •  
Thomas KesslerCMS
  •  
Todd Omundson
  •  
ZeOmega
  •  
Emily TenEyckCAQH
  •  
Mark Taylor
  •  
Julia SkapikCognitive Medicine
  •  
Michael BrodyCME Online
  •  
Michelle ZuttermanHumana
  •  
Surescripts
  •  
Laurie DarstMayo
  •  
Marianna SinghCAQH
  •  
Labcorp
  •  

  •  
Mariana SinghCAQH
  •  
Madhuri
  •  

  •  
Bob THompson
  •  
Ben LangleyMITRE
  •  
Michelle PriestAllscripts
  •  
Michael Hurley
  •  
Cedars-Sinai
  •  
Roland Gamache
  •  
Dave HCRT INC
  •  
Barbara WoodPNC
  •  

  •  
Padma KondaveetiMettles
  •  
Unknown User (meryl_bloomrosen)Premier
  •  
Cambia
  •  
Judy Williamson
  •  
Matthew Maurer
  •  
Smitha HarishMettles
  •  
BC Idaho
  •  
Michael LunzerAltegra Health
  •  
Rush
  •  
Shilesh NairGdit
  •  
Steve Favilla
  •  
Optum
  •  
Texas Health
  •  
Keya ShahCasnet
  •  
Epic
  •  
Josh Lamb
  •  

  •  
Edifecs
  •  
Max MD
  •  
Allen SaundersChange Healthcare
  •  
Molly Malavey
  •  
Rich BlochLumedic
  •  

  •  
Thomas GrannanAzuba
  •  
Beth ConnorCMS
  •  
MA Health Data
  •  
Kellie Ruff
  •  

  •  

  •  
Mark Fleming
  •  
Kumar Elubandi
  •  
CMS
  •  
MITRE
  •  
Howard Kong
  •  

  •  
MITRE
  •  
Yolanda Liu
  •  
Merri-Ellen JamesCMS
  •  
Mick O'HanlonMITRE
  •  

  •  
MITRE
  •  
MITRE

Present

Name

Affiliation

  •  
Rachel GoldsteinCAQH
  •  
Ralph Saint-PhardHealow
  •  
Susan LestinaAHA
  •  
Briana BarnesScope Info Tech
  •  
Cerner
  •  
Cassandra Bell
  •  
Deepthi ReddyMettle Solutions
  •  
Cognosante
  •  
Humana
  •  
Prashanth Golconda
  •  
Rajesh GodavarthiMCG
  •  
Rim Cothren
  •  
Scott LawrenceCMS
  •  
Chris JonesHumana
  •  
Christina BorgLumeris
  •  
Julie MaasEMR Direct
  •  
Kathleen Connor
  •  
Matt ReidAMA
  •  
Mike BerkmanCoverMyMeds
  •  
Monse SerenilHumad
  •  
Rian RaineyCoverMyMeds
  •  
Sandra StuartKP
  •  
Sheryl TurneyAnthem
  •  
Wanda Govan-JenkinsHHS
  •  
Chris HutchinsonCoverMyMeds
  •  
Anna MeisheidCMS
  •  
Cyrus PeyrovianFastAuth
  •  
Janice BakosAetna
  •  
SureScripts
  •  
Gevity
  •  
Melanie JonesCMS
  •  
eClinicalWorks
  •  
Tammy SchreinerWPS Health Solutions
  •  
Amy PetersonHumana
  •  
Dave Trotter, MD
  •  
BCBSIL
  •  
Renee FullerIBX
  •  
Helina Gebremariam
  •  
Cambia
  •  
Intepro
  •  
Carradora
  •  

  •  

  •  
MaxMD
  •  
Cindy Monarch BCBSM
  •  
Dawn PerreaultBCBSM
  •  
Cognizant
  •  
Mitre
  •  

  •  
Missy BoserSurescripts
  •  
CAQH
  •  
Phranil MehtaeClinicalWorks
  •  
Dylan TuggleBCBST
  •  
JPSys
  •  
Mario JarrinChange Healthcare
  •  
Jim AdamsonArkansas Blue Cross
  •  
Brian PoteetBCBST
  •  
Tony LaurieNoridian
  •  
Optum
  •  
Bonnie SirottZeOmega
  •  
MCG
  •  
ESAC
  •  
Geeta KrishnanEdifecs
  •  
Katherine LuskChildrens
  •  
Michael NovalesBCBSIL
  •  
Tracey McCutcheonKPMG
  •  
Anupam ThakurBCBS FL
  •  
Cathy PlattnerKP
  •  
Srinivasarao EadaraesMD
  •  
Availity
  •  
ZeOmega
  •  
Dennis ZanettiNantHealth
  •  
Haris BegCambia
  •  
Kishore MetlaMettle Solutions
  •  
Sunitha Godavarthi
  •  

  •  
C-HIT
  •  
SriniesMD
  •  
Anthem
  •  
Kumar SourabhGRSI
  •  
Julia ChanCW Global Consult
  •  
Ric LightHumana
  •  
UHC
  •  
Anil VezendlaMCG
  •  
Ken LordBook Zurman
  •  

Scott Robertson


  •  
Christopher GraconIndependent Health
  •  
Gary GryanMITRE
  •  
MITRE
  •  
Marty StaszakVoluware
  •  
Stephen ReckfordGRSI
  •  
Joe HamiltonUnity Point
  •  

  •  
Dave Foster
  •  
Betty SullivanAllscripts
  •  
Cigna
  •  
Juzer KhorakiwallaUHC
  •  
Unknown User (patricekuppe)Surescripts
  •  
Express-Scripts
  •  
Celine LefebvreAMA
  •  
Eshaa DhalleClinicalWorks
  •  

  •  
Aakash DeliwalaeClinicalWorks
  •  
Chris JohnsonBCBSAL
  •  
Megan RileyMITRE
  •  

  •  
Crystal HyattTransunion
  •  
Epic
  •  
AEGIS
  •  
BCBSM
  •  
Pawan RegmiRush
  •  
Rajesh GarlapatiRush
  •  
Rush
  •  
Scott HoltItiliti Health
  •  
Cigna
  •  
Cigna
  •  
UHC
  •  
Steve KirbyCoverMyMeds
  •  
Neena DakuaWPS Health
  •  
Evicore
  •  
Med Allies
  •  
Laurie Henson
  •  
Healow
  •  
Bapi Beshara
  •  
David Delano
  •  

  •  
Vishnu
  •  
Priyanka Madria


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Reminder: conference call structure & name changes
  1. Burden Reduction (CRD/DTR/PAS) Implementer Support Call - Wednesday, DTR time slot (11at ET)
  2. Burden Reduction (CRD/DTR/PAS) Supplemental Examples - Friday, PAS time slot (3pm ET)
  3. Burden Reduction (CRD/DTR/PAS) IG Updates/Future Requirements - call to be scheduled, Mondays at 1pm ET


HL7 Patient Access API Implementation Event

Registration: https://www.hl7.org/events/fhir/implementation/2020/

  • Virtual, August 17-19
  • 1st day - kick-off, education
  • 2nd day - education
  • 3rd day - implementation day


HL7 Sept Connectathon

2020-09 Connectathon 25



Documentation Requirement Lookup Service (DRLS) Presentation

(Ashley SteddingLarry DecellesNalini Ambrose)

  • Working on first 10 rule sets - how many total rule sets would there be?
    • Rule set for every DME item or service that is covered under Medicare Fee For Service
    • 1 DME item could have multiple rule sets based on grouping of clinical data elements (e.g., order, assessment, progress note, etc.)
  • How did you transform PDFs, Word docs, into actual rules? What's involved in that?
    • Current process - CMS has developed a set of PDFs that consist of 2 parts: Clinical Data Elements (CDEs), and another document called a template which describes the documentation requirements needed for a particular topic
    • Informaticist takes these documents and map to FHIR based resources - also map to value sets (or created if not able to identity an appropriate value set)
    • Tool used to create the templates/questionnaires from NLM (National Library of Medicine)
    • Also create CQL (Clinical Quality Language)
    • Do a lot by hand right now, but looking to use CDF Authoring Tool - can generate CQL - historically geared toward eCQMs - upgraded tool to FHIR R4 and trying to incorporate into process
  •  Home Oxygen Therapy - do the words get someone to the right questionnaire?
    • Mapped to HPCS codes
    • When call out to CDS library to retrieve the questionnaires and CQL rules, primarily use HPCS codes


Identify workflow exceptions/gaps to address for production 

(Sreekanth Puram)

  • CRD/DTR/PAS Workflow - Examples, Exceptions and Gaps
  • Use Case 1 - Happy Path
    • Some assumptions made to follow happy path have not been found in real-world/production scenarios
    • Scenarios related to Stress Echocardiogram:
      • Automatic approval
      • Human review and subsequent denial
      • Human review and subsequent approval
  • Question re: PA approval coming through - what's the time lag?
    • Following real-time requirement 
    • CQL based approval system
    • Total time from submission to response is about 15 seconds
    • Approval response time is dependent upon payer app system being able to process request (might receive pend status first)
      • That pend scenario would be an 'exception' use case that we'll also work on later
      • There's manual review if payer has to look at documentation, but if it's all structured data and the payer has an automated way to adjudicate (e.g., CQL) you can have a more real-time response
  • Start reviewing exceptions in upcoming meetings (payer side first, and then EHR side)
  • CQL will be availbale in GitHub


Next agendaContinue reviewing use cases to identify gaps
 Adjournment

Adjourned at 4:02pm ET

Outline Reference

Supporting Document

Minute Approval



Tasks

  •