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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
  •  
Jia Chen

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

Follow-up on sensitive health data and its representation of information sensitivity/confidentiality in PCDE bundle

  • Planning to submit a question to CMS
    • Question focus is on individuals having to release it separately from general set of PHI or USCDI information that a payer has
  • Should make it clear in the IG that if the information related to current treatment is considered sensitive by state or federal law then it has to be authorized for release by the individual, and can't automatically be exchanged for care coordination
  • PCDE not scoped to determine what is sensitive health information and what should be tagged with a security label; however, if implementer needs to do it, need to provide guidance on how it should be represented


Review PCDE example that shows inclusion of Explanation of Benefits in an PCDE bundle.

  • Today, won't have claims submitted in FHIR format
    • If trying to represent a claim, will have to do it in X12 format
    • If trying to represent EOB, because of Blue Button, we do have an expectation that for those covered plans an EOB will be available in FHIR format
  • For PCDE, remove claim and add document reference for scanned claim attachment?
    • Put original X12 in the document reference
    • Base 64 encoded as content of the document (not a PDF)
    • Challenge is that what gets shared in PCDE is a stripped down version - not all info that exists in the claim is approprite to be shared - do systems have ability to 'prune' the content in X12 format? would downstream system be able to process it, if the pruning made the X12 invalid?
    • For coordination of benefits the original claim is shared 'as is' - assuming that we can share the original X12
    • What is the MIME Type for raw XML? EDI-X12
    • Do the same thing for a 278 for prior authorization


HRex IG Dependency - Task
  • New HRex publication includes a profile on Task that allows requesting of data (shared between PCDE, CDex IGs)
  • Do we want to update the profile in the draft of PCDE continuous integration build to point to that prior to Connectathon and prior to HRex ballot, or leave temporary profile that we have in PCDE right now for Connectathon, and update it post-Connectathon?
  • Basic changes
    • Task code
    • New Task input to identity what you want to receive is a PCDE document
    • Code that identifies result
  • Team agreed to make the change
  • Melanie Combs-Dyer will give Sreekanth Puram a heads up - this change will impact his code

ManagementNext agenda

 Adjournment

Adjourned at 2:30pm ET


Supporting Documents

Outline Reference

Supporting Document

Minute Approval
PCDE Supplemental Guide

Payer Coverage Decision Exchange Use Cases


Action items


Create Decision from template