2021-06-10 Risk Adjustment Use Case Meeting

CMS HL7 Connectathon July 20-22, 2021. 

• Free Event. Registration ends July 1st, 2021.
• Confluence page: CMS 2021 - 07 Connectathon 2
• Risk Adjustment information session: July 22nd 4:15-5pm ET

Attend the free event for CMS connectathon. 

FHIR Risk Adjustment PSS 

• TSC approved on 6/7/2021

Da Vinci Risk Adjustment FHIR IG Proposal

• CQI WG reviewed and approved on 6/4/2021
• On FMG agenda 6/16/2021 for approvalI

TSC approval for the project scope statement. 

CQI WG- made some minor changes to the FHIR IG proposal. Next being placed to FMG agenda for approval.

Continue with requirement gathering and FHIR analysis discussion

Patient Resource

• using First Name, Last Name, DOB, unique member ID
• anytime we use an identifier- it needs to identify one individual, so cannot use the subscriber ID as it may be related to several individual
  • identifiers from the payers- they may send it to the providers so it can be sent back to payer to help their system identify the member
• SSN- would suggest to remove it rather than leaving it as optional as it may confuse others to believe that they will need it. 

ID is different than Identifier

ID does not change. 

Identifiers are numbers assigned to patient and could change.

US Core requires system and value with identifier

Coverage Resource- intended to relay insurance information

• in respect to coverage, all identifiers fall under the subscriber ID
• coverage points to patients and its beneficiaries
• use payor to identify organization

Brand Name field

• name that the payer does the business as. Name may change based on Market, not considered the Parent name entities. 
  • becomes important when it is For profit and Non for Profit. Different rules for either organization

Contract Type field

• contract ID, how the ID is related to the contract, ie Medicare Advantage.
  • there is an H plan number for the payer, for the member
  • HCC gaps are typically associated with H plan for the member
  • Do we need contract and plan ID for HCC gaps?
  • May need to leave these out if able to cover them with Attribution

continue with requirement gathering