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

Chair:  Robert DieterleMay Terry

Scribe: Phung Matthews
 

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
  •  

  •  
Swapnil
  •  

  •  
Phung Matthews


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 FHIR Connectathon - Virtual, Sept 9-11

PCDE Demo Updates May Terry

  • Based on feedback, the following has been updated 
    • PCDE Bundle
      • Claim for operation in medication requirement- is a FHIR resource from Outcomes
      • Medication dispensed is now included
    • Decided to use EOB rather than Claim- the example will be revised to include EOB


PCDE Supplemental Guide

PCDE Supplemental Guide

  • Presently a preliminary rough draft
  • Added sensitive health information
    • Leverage FHIR security label
    • Place snippet example (CarePlan4)
      • Meta security- confidentiality level follows FHIR security IG
      • 2nd set under security as restricted
      • codeable concept inside bundle
      • Condition also has security and should be applied at all resources it is referencing
    • references are represented and resolvable 
    • ensure the use and consistency of marking confidentiality on sensitive information, i.e. the application of confidentiality should be consistent on resources to which it is applied
  • Robert Dieterle will ask CMS if payer to payer becomes protected data or is patient right to cover?
  • consider privacy requirements from state to state- one state may be more or less restrictive than the other state


Flesh out clinical scenario to reflect PCDE payload



ManagementNext agenda
  • Take a moment to look at the supplemental guide
  • Discussion regarding modifiers and representations



 Adjournment

Adjourned at 03:02PM ET


Supporting Documents

Outline Reference

Supporting Document

Minute Approval
PCDE Supplemental Guide

Payer Coverage Decision Exchange Use Cases


Action items


Create Decision from template