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Chair:  @MaryKayMcDaniel   Scribe: Jeff Brownand Kathleen Connor

Call Logistics: 

This call is at 11 AM ET, 10 AM CT, 9 AM MT, 8 AM PT
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Attendees - list maintained at the bottom of the meeting notes

Steps for STU-1 publication:

1) load ballot comments into JIRA
2) identify technical block votes
3) substantive, propose dispositions, bring to the Monday CARIN call, block vote on FM call
4) update the guide
5) send ballot worksheet and updated guide to all ballot voters (and give some period of time to review) and withdraw negative comments

ALL comments must be resolved. Do not need to vote again. Becomes an STU-1.

PSS approval flow:  Sponsoring WG, Co-sponsors, US Realm, Management Groups, Steering Division, TSC

ID - Local to the resource creator, IDENTIFIER - an identifier everyone recognizes. Independent of where the information is created or by whom

  Agenda Outline

Agenda Item

Meeting Minutes from Discussion

"Agenda in Brief"

details follow

Review agenda - 

Review/Approve 8/4 Meeting minutes


September WGM Meeting times/agenda

Need volunteer to research Primary DX/Principal DX on claims/admitting DX

Vocabulary Updates - UTG Fixes needed.

Volunteers to review the errors and help identify the fixes

Block Votes:

Da Vinci

PlanNet Block Vote #3, 

Risk - ATR - 1 JIRA Ticket:

Da Vinci review of PAS IG - Jean Duteau

CARIN JIRA Ticket Votes

eVote did not meet quorum


2 Eric Haas 1 Mark Roberts 1 Pat Taylor 1 Paul Bastide 1 Paul Church

R5 Work:

Concepts/Nomencature Small Group work Review, continue

Organizational Unique Identifiers (NCPDP or Experion or CMS)


Payer Identifiers

Paul and Celine other commitments

CARIN:  lock vote 7 and Name change for next week. 9/1


  • Reviewed WGM agenda topics
    • Topic: Primary vs. Principal diagnosis issue
    • Bob explained that the issue revolved around clinical being SNOMED-CT and payer being ICD-10
    • Mary Kay felt the topic was different and presented slide deck that she received which was discussed (slides created by Floyd Eisenberg).
      • Issue was complicated by the fact that an in-patient stay can consist of many encounters.
      • Questioning why this was supposed to be coming from CARIN?
      • Pat Taylor will do research for claim in preparation for WGM
      • “How do you make the encounters equal a claim?” basically a mismatch of clinical information and payer information.
      • Co-chair for all involved groups are asked to attend the meetings.
  • Vocabulary issue fixes
    • Mary Kay presents brief history of move from Harmonization to UTG
    • QA Report produces errors
      • Mary Kay requests volunteers to help review errors related to FM

Weekly Call Minutes

Review & Approve 8/4 meeting notes

Accepted by unanimous consent.

  • Calls - listed to the right
  • FM - Ballot Reconciliation Resources:  FM - Ballot Reconciliation Resources
    • Started a new confluence page to list all ballot reconciliation resources. If anyone has any that are not listed there, please update and let the rest of us know!!!
  • Ballot Cycle Dates:

Normative ANSI Standards approaching expiration

FM has none.

STUs Expiring in Next 6 Months

FM has none.

All deadline dates can be seen on the new Balloting, Content Submission, Voting, and Working Group Meeting Schedules on Confluence at:

January 2021 Ballot Cycle

August 23, 2020

TSC Approval of the PSS

November 1, 2020

NIB Deadline

May 2021 Ballot Cycle

October 9, 2020

Submit Work Group Approved PSS to the PMO

December 18, 2020

TSC Approval of the PSS

March 7, 2021

NIB Deadline

September 2021 Ballot Cycle

February 5, 2021

Submit Work Group Approved PSS to the PMO

April 23, 2021

TSC Approval of the PSS


NIB Deadline

January 2022 Ballot Cycle

June 11, 2021

Submit Work Group Approved PSS to the PMO

August 13, 2021

TSC Approval of the PSS

No call September 22, WGM.

Additional Calls this week.

Set up all calls as they were:

  1. Accounts, Payments, and Statements at 4pm ET Thursday
  2. CARIN Alliance - Consumer Directed (BB) Ballot Reconciliation 2:30ET Monday
  3. CARIN Thursday Aug 6 going forward at 11-12 ET 
  4. The Gender Harmony Project - Vocabulary WG EOW Monday 4pmET

**See HL7 Conference Call Center for Da Vinci Calls

ONC Tech Forum next week. (Paul, MK, Linda, Jeff, Rachel, Mark, Bob). Cancel the HL7 FM call for next week.

New PSS Review

Instructions for how to review a project proposal are available here:
Please consider the following in your review:
• Does this project fit into my Group's Mission and Charter and should we be a sponsor, co-sponsor or an interested party?
• Is there an ongoing project(s) in my Work Group that are similar to this one that may overlap? If so, provide details in your comment.
• Is there a project(s) underway in other Groups that are similar to this one that may overlap? If so, provide details in your comment.
• Are you aware of a project(s) outside of HL7 that may overlap with this project?
• What other Work Groups should be considered as co-sponsors or interested parties?

7/28/2020:    NONE


1) Bob and Paul have a to-do:  R4 only notation to PSS, since REG specifies R4.

3/24/2020 - In Process

4/7/2020 - emails and documentation sent out to all balloters

5/5/2020 - Bob will update the PSS for TSC Review

5/12/2020 - Bob an d FM Co-chairs will update CRD PSS (it was the old process, need to update in Project Insight)

5/19/2020 - Bob. CRD, no pss changes/PDex ready to go, Paul will sent to TSC for eVote. CDS/CIC-DTR/HREx to Sponsors. Patient Care - CDex (not ready to ballot, so we have time). 

5/26/2019 - CRD/PDex to TSC. DTR is going to CIC. CDex in process.

FM approved date: 4/21/2020, CRD/PDex. Bob Dieterle/Laurie Burckhardt. 23-0-0

6/9/2020. Motion to accept removing support for STU2 and STU3 from HREX PSS and Implementation guide:

Bob Dieterle/Mark Schrimshire.  16-0-0

6/16/2020. Bob to PIE, CIC and Patient Care. 

6/30/2020. Bob working with Patient Care to get signoff

2) Schedule a joint with PA over the summer to touch base. Wednesday at 3pm.

3) Gender Harmony PSS 1387. FM CoSponsor. Who is monitoring? On Co-chair call agenda for 7/1/2020.

4) 4/27/2020 TSC Agenda Item. 3/3/2020:  In Process. ***follow-up:  setting up CARIN as a separate group (as DV) - include Frank and Amol on email. Add this to the Accelerator start-up todos list. Ability to add calls. MK/Paul need to bring up at TSC. 

5) Extensions across profiles: Modeling and Methodology (MnM)

5/5/2020: FHIR-I took a stab at place to put extensions across profiles. Work in process.

5/12/2020: proposal fell apart at MnM - next call today, 5pmET

6/2/2020: Next MnM call 6/9/2020

6/30/2020: Next MnM call 7/7/2020

6) Common Profiles/Common Extensions

  • TO DO:  start building out a list of FM specific profiles registry until one is created for all HL7 Profiles (easy search and find)
  • For DV the common profiles are being put into HRex. Will that need to change in the future?
  • There are standard profiles and extensions that are currently in the FHIR specification. BUT, not all IG level profiles and extensions are there. Creating a common instance should make things easier. Create a common repository.

7)  FM to do:  Need to put together a list of .identifiers that are used in claims and EOBs to include how to match the 2

6/9/2020: Co-chair to do:  

Where are we at with vocabulary? Does everything have to go through UTG?

8/25/2020. That depends. If you want to create uniformity, yes. Should go through UTG. If the Naming System/Code System/Value Set are unique to an IG, no. Strongly encouraged to go through UTG for all terminology.

FHIR Tracker Items. 

******************NONE, at this moment in time......

V2 Tracker Items.

tracker #25203 to add use cases. see:  V2 Identifiers

tracker #25193 to update the IN2-25, IN2-26, and IN2-27 field definitions.

Email thread is located at: V2 Questions - tracker #25203/#25193

Tracker:  15632: V2 GForge Ticket 15632 - PRT1:14 is broken

2020 06 04 Updates:

We have identified the changes needed and sent an email to V2-MGT to get next steps. New publication process for both V2 and Vocabulary. Yay! 2 new processes to navigate to make this change.

Positive, only new V2 update process to navigate once complete

Move to new version

Opportunity for FM to update descriptions on resources and the descriptions of the code sets. Update the actual code sets, can't change the binding strength. 

Need to prioritize:

1) the resources that need to be reviewed

2) the code systems that need to be reviewed and updated (EXAMPLE). are they really an example or can they be 'updated' to the correct /updated value set

3) map resources to RIM (reference implementation model)

4) vocabulary needs (see separate row below)

Add to 8/25 Agenda: 

Address how we will manage/handle NCPDP Unique Person Identifier.  Is this a candidate for addition to US CORE, do we need to add to our IGs. 

8/3/2020. R5 Timing.  January 2021 is not doable for FM. Prefer 12/2021, but some changes could be put into May.

8/25/2020: Coverage.type. Missing a data element. leave Coverage.type and add a new element, per the WG notes.

***CMS Regulation below refers to:

The Interoperability and Patient Access final rule (CMS-9115-F):


Confusion among the implementers between CARIN BB and PDex (immediate 2 that seem to be causing confusion) & JIRA Tickets. 

There is a graphic 

 and word document:

(words to explain the graphic) which have been created as a response to 2 JIRA tickets:

FHIR-26699 :  There is clear overlap between this implementation guide and the DaVinci payer data exchange and clinical data exchange implementation guides

FHIR-26733 :  Clinical FHIR artifacts should be mentioned in this guide

As FM we need to review (and update if needed) and figure out where all to POST, INCLUDE, PROMOTE these for industry understanding.

CARIN BB Payer to 3rd party app for person

DV PDex Payer to CMS person API (3rd party app) or Payer-to-Payer for representing 'clinical' concepts, DX/ICD-PCS, HCPCS, represented in resources that represent concepts represented in Procedures, Observations, Medications, Condition

at the time PDex was created the providers are interested in dates, who did it, etc. 

Questions to FM: how to include the same information in both the IGs.

CARIN Update:

Consumer Directed Payer Data Exchange (AKA BB)

7 minutes 

3/24/2020: This guide supports CMS Regulation***. Reg date is 1/1/2021

  • CARIN BB PSS got ARB and TSC approval OCT 2019
  • FMG suggested new name 11/X/2019.
    • Consumer Directed Payer Data Exchange
  • CARIN NIB review, IG review  CARIN Blue Button IG Proposal. Been through a Connectathon based on draft content., FM reviewed and approved NIB 11/5/2019

 PSS for CARIN Blue Button

CARIN BB confluence ballot reconciliation page:  Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) Ballot Reconciliation

1st Item:

5/12/2020:  Need to take 'CARIN BB' or 'CARIN Blue Button' to TSC. Can we use the 'Blue Button or BB' as key lookups, etc?

5/19. Paul/MK need to take to TSC  meeting on 6/1 for confirmation: Can Tag under which artefacts are cataloged, then there are the short names contain the "BB"

6/9/2020 TSC Feedback. Please forward written permission from CMS. HL7 HQ will follow-up with CMS for the same approval. 

6/16/2020-6/30/2020 Awaiting feedback from CARIN. Lorraine Doo will help facilitate.

7/21/2020. Emails from ONC. Need JIRA ticket for changes needed to IG as a result.

Need to approve a new name: Then will need a name change for the IG to go to MGMT committees for approval. 

7/28/2020. New name:  Consumer-Directed Payer Data Exchange Implementation Guide (CARIN IG for Blue Button®)  

Name Change

"C4BB" - Carin For Blue Button

Formal name: Consumer-Directed Payer Data Exchange Implementation Guide (CARIN IG for Blue Button® (C4BB))

Canonical URL:

Profiles, Friendly Name:  C4BB Patient, C4BB Coverage, C4BB Location

Profiles url ‘pattern’:

CARIN meets tomorrow and Thursday. Pat will tee this conversation up and then Monday TSC, Wednesday FMG, US Realm, Jeff will take to ARB on Thursday.

Formally change the Formal Name at publication, via the publication request. 

2nd Item

Follow-up on pre-applied JIRA Tickets.


Yes, there were changes made prior to FM ballot recon approvals.

Grahame working on tooling to be able to identify changes between the 2 versions and they can make sure all changes are anchored to ballot reconciliation tickets. 

Grahame will report out at FMG when the tooling is completed.

3rd Item: 

JIRA Ticket 26693.

Learning conversation, agreement in approach. Document will be updated. Lisa asked that the implementers be allowed to review. Bring back next week 7/7.

-needs more thought. the document will be updated and returned. 

-need to be able to get to a record in a specific point of time 

-not been a focal point of concentration in connectathons to date

8/25/2020 Block Vote #6 - see below, for vote.

3) Personas


New document sent out. After call with CMS, Dave Hill was going to send to Denise St. Clair. There are questions from the AMA that have not been addressed. Now awaiting feedback from CMS. Pat shared the new document with the FM Co-Chairs.

Awaiting feedback from CMS.

8/3/2020 - Status. Awaiting feedback from CMS


  • CARIN Block Vote 2b
    • eVote did not meet quorum requirements
    • 32 tickets included in Vote 2b
      • Mark Roberts being asked to provide breakdown of the tickets
      • Bob D. provides his technique for this information
      • Mark R. complains about the work involved
      • Bob D. looked up the information…
        • 1 celine
        • 5 Eric
        • 1 Lisa Nelse
        • 1 Mark Roberts
        • 7 Pat Taylor
        • 11 Paul Knapp
        • 3 Saul
        • 1 Tom Koon
        • 2 Virginia

Block vote 2b. Motion to approve:  Mark Roberts/Pat Taylor. 8-0-1

Block vote 6. Motion to approve: Mark Robert/Pat Taylor. 8-0-1

Block vote 7 and Name change for next week. 9/1

 DV Update

20 minutes 

The Da Vinci IG Dashboard:  Da Vinci Implementation Guide Dashboard

Da Vinci Update


Da Vinci IGs: 

Coverage Requirements Discovery (CRD)

3/24/2020: Implementation of this guide is not required by the CMS Regulation***.

Documents, Templates and Rules - DTR

DTR - STU-1. Re-ballot (Ballot for Comment previously - comments resolved). SEP Ballot

3/24/2020: Implementation of this guide is not required by the CMS Regulation***.

HRex (Common across IGs – i.e., post/put without all use case details ) - Approved Monday 6/17/2019

3/24/2020:  Used by guides that support the final CMS rule. By itself it does not support the final rule***. 

Notifications: - Feb 2020 Ballot

3/24/2020: This guide supports CMS Regulation***. Reg date is 6 months from publication

Payer Coverage Decision Exchange: Portability of current treatment, STU-1, SEP 2019 Ballot

Payer Coverage Decision Exchange: 

3/24/2020: This guide supports CMS Regulation***. Plan to Plan 1/1/2022

Provider/Payer Clinical Data Exchange (CDex) (infrastructure)- Approved Monday 6/17/2019

3/24/2020: Implementation of this guide is not required by the CMS Regulation***.

Payer/Provider Data Exchange (PDex) - :  Approved by FM WG 6/11/2019

PDex IG:

3/24/2020: This guide supports CMS Regulation***. Plan to Plan 1/1/2022

3/24/2020: This guide supports CMS Regulation***. Plan to Member 1/1/2021

PDex Plan Directory IG:  : Early FEB 2020

3/24/2020: This guide supports CMS Regulation***. Plan to Member 1/1/2021

PDex Plan Formulary - - approved by pharmacy 6/11/2019

3/24/2020: This guide supports CMS Regulation***. Plan to Member 1/1/2021

PAS, STU-1, JAN Ballot

Prior Authorization Support:

3/24/2020: Implementation of this guide is not required by the CMS Regulation***.

Risk-Based Contracts Member Attribution List project, FHIR IG Review

3/24/2020: Implementation of this guide is not required by the CMS Regulation***.

-->updated PSS for Value Based Care Member Identification (Updated) that includes the secondary use of Bulk Data Exchange along with the member list and the data definitions in other Da Vinci IGs (e.g. PDex) to define the scope of data that should be exchanged.

preparing a FHIR IG and we are working towards balloting for the upcoming Feb 2020 cycle. link to the IG proposal is here: 

NIB review and approval:  11/19/2019.

4/7/2020: Approved Block Vote #1:  filter for 4/7 is available to anyone logged into JIRA here:

5/5/2020: Approved Block Vote #2:

5/5/2020.Bob D. Update: Single biggest issue is to land on exchange methods (path vs. communication request - content and exchange method very intertwined). What exactly do we use for consistency and what will the vendors be willing to support. Viet and Bob are working on this and it will be implemented across the guides. Payer coverage decision exchange and PDex. how to you ask someone to do something that requires manual intervention. still in process.

Paul: One more overall issue. When you have complex information that you are returning, something that requires more than one resource. Two ways to deliver that information. you can either deliver all of it in a package (bundle). OR you can deliver it granularity - one resource at a time. you can ask for a provider, then next resource. If you choose the latter approach, you won't get the same answers out of the 2 approaches. Option 1 you can get all the information contextually. If you choose the 2nd you will get the current version, may not be the version at the time.

Bob:  IGs are attempting to give the receiver enough information to make a decision. there may be a 2nd query to get the rest of the information.

Paul: must give people enough information so they can come back and get the right resource instance. 

Bob: Yes. Depends on the IG. 

Paul: the instance version in context is not generally understood. 

Lisa: and there is no clear indication or committment on the part of the vendors. 

Bob:  how do we take into account the different way this will be implemented. Endpoint only vs. instances.

>>>Need to continue this discussion next week (5/12)

>>>didn't discuss 5/12 - take to 5/19. 

8/25/2020: PDEX Plan Directory, aka PDEX Plan Net

Block Vote #3:

  • Da Vinci Plan Directory (aka Plan Net) block vote 3
    • 13 comments in all
    • Motion to approve: Bob   /  Second: Mark Scrimshire
    • 12 in favor, 0 Abstains , 0 Negatives  (12-0-0)

8/25/2020: Risk Based Contracts:  Member Attribution:

  • Jira Ticket (Dragon) FHIR-25963:
    • Motion: Dragon    Second:  Mark Scrimshire
    • 14 in favor, 0 Abstains, 0 Negatives (14-0-0)
  • Dragon gives update – Risk Based Contracts: Member Attribution
    • Sept 8 scheduled for FM overview of content

8/25/2020: PAS - Regroup. Jean absent.

High level overview by Jean Duteau to help group begn their review of the document.


All about vocab


  • Register Code systems and value sets for use across implementation guides.
    • How do we do this across all IGs using the same code systems and value sets?
    • Register them in the UTG


Value Sets for Coverage Levels and Payment Types

2) What IGs are impacted by:

5 Code Systems (NUCC, CARC, NUBC)

3) Large amount of work to do.

1) validating existing OIDs/code systems/ value sets in play across HL7 versions (research that is painful and time consuming)

2) updated new code system/value sets and then going back to depricate those that are questionable

4) R5:  Vocab in conjunction with RTPBC: Adjudication value set.  see:

  • FM will add this to the "Adjudication" vocabulary 
  • Amol question: are we tracking identifer type. CN for payer claim number. DV has a UMB. Are we keeping track of these additional value set codes? 

5) 8/4/2020: Need to FIX this!!!

UTG:  create naming system and value sets and send to UTG (Ted). 

6/8/2020 Update:

AHA-NUBC, Pattern created. Given to Developers to use. Waiting to see what it looks like in an IG/UTG and will reach out to AHA-NUBC contact for approval.

AMA - CPT:  should be ok to go. see: Make sure you read all the way to the bottom!!! need the implicit value set URL is a value set that includes all CPT codes. 

CMS - DRG, POS, RARC. in-flight. POS pretty close. 

NCPDP: DAW, Prescription Orgin Code, Plan reported brand - generic code.  DO we have V2/V3 Code System/Value Codes for these already? IF NOT: IF the pattern holds up, will reach out to NCPDP via HL7 Liaisons (Scott Roberts and Jean Duteau) to NCPDP Liaison (Margaret Weiker) to confirm. Research needed. - Pattern created. Developers using. Waiting to see what it looks like in IG/UTG and will reach out to for approval.

6/16/2020. brief overview to the WG on progress to day.

Conversation around multiple Code Systems with different IP licenseure in one element. Pat will bring an actual example to the group and we will walk through it. 

Account, Payment and Statement 

Work Effort Update

5 minute 

Invoice/Statement/Payment Work WG introduction to effort

Look for emails/doodle polls for meeting times and dates.

PIE WG will be included. 

Calls on Tuesday's. See FM Conference Call for details.

Insurance Concepts. 

Create definitions

Health Care Insurance Concepts/Nomenclature

Linda Michaelson is willing to drive:  please send her an email if you are interested:

Old version:

FHIR 4.0 FM page link:

Gathering Concepts:  Example of concept:  "The individual who owns the policy", "The individual who is being treated"

Documentation can be found at:

Concept/Nomenclature Definitions

8/4/2020:  Continue Review work done by small group

Coverage.Order. In the US the coverage order is actually done via the Encounter. The order of the insurance on that resource drive the order of the coverage.

Copay.percentage/Copay.amount. may need more codes added

Same for .deductible - need to curate the appropriate code sets

Next Steps:

Working from the confluence page. We will review for JIRA tickets. Will begin reviewing on the next meeting with the group. (block 30 minutes per call)

Anesthesia Billing Support Update

5 minutes


Meeting once a month. Next meeting:  

***Documentation here:  Anaesthesia Billing Support (under documentation)

***PSS:  PSS for Anaesthesia Billing Support

Preparing to create the V2 IG using the NIST tooling.

4/17/2020 - Pause in effort

Payer Identifiers

Identifiers that are used to identify a Payer

2020 03 03: Kathleen, research has been done. Needs V2 CR.  V2 - Kathleen/Donna work, any updates or discussion needed? KC - RE: Clarify IN1-36 & 49, IN2-61 Member ID.  Analysis done, guidance drafted. Just need to create V2 CR to add guidance and have WG approve to submit.

See:  V2 Identifiers

Needs to be a CR for V2

There are identifiers that are issued by Payers. Things like member id, group id, etc. Those are already covered within the Coverage Resource. (Member id - Coverage.identifier, Subscriber ID in the subscriber ID). Other identifiers go in class. 

Two conversations going on:  how do we identify a payer. There is not a consistent way to identify a payer in the US. There is no 'authority' that creates an "NPI" for a payer.


Backlog rows have been moved to:

Parking Lot - Things we need to address



Need to add DRG at the root, currently at line in procedures. Analysis work to be done, then JIRA Ticket needed.




Co-chairs agree

Base it on v3 FICR DMIM


Open Discussion

Next MeetingNext Tuesday.


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