Chair: Paul Scribe: MaryKay McDaniel
This call is at 11 AM ET, 10 AM CT, 9 AM MT, 8 AM PT
Find your local number: https://us02web.zoom.us/u/kfWlHSVu3
Attendees - list maintained at the bottom of the meeting notes
Antitrust Statement (HL7 GOM §05.02):
Professional Associations, such as HL7, which bring together competing entities are subject to strict scrutiny under applicable antitrust laws. HL7 recognizes that the antitrust laws were enacted to promote fairness in competition and, as such, supports laws against monopoly and restraints of trade and their enforcement. Each individual participating in HL7 meetings and conferences, regardless of venue, is responsible for knowing the contents of and adhering to the HL7 Antitrust Policy as stated in §05.01 of the Governance and Operations Manual (GOM).
|Meeting Minutes from Discussion|
Remember the Antitrust Statement, see above
V2 to FHIR Mapping Review/Updates.
OO: 2-To-FHIR Project - Orders & Observations - Confluence (hl7.org)
Weekly Call Minutes
Review & Approve Interim Meeting 3/14/2023
Change PMM to FMM
Accepted with the change above.
2023 May Ballot Cycle
2023MAY, Mar 31, 2023 - May 01, 2023
Add to 3/28/2023 FM Call. Review Projects and timelines. Identify projects to be addressed at the WGM in May.
Add Patient, Person and RelatedPerson as choices in PaymentIssuer
Made changes to paymentReconciliation https://jira.hl7.org/browse/FHIR-37920
paymentIssuer CANNOT be Person
R5 - need to reword the roadmap section
13.0.17 Developmental Roadmap
The Financial Management Work Group (FM) is responsible for two subdomains:
Financial Accounts and Billing (FIAB) - resources for accounts, charges (internal costing transactions) and patient billing, and
To date FM has been focusing on the resources required to support the exchange of claims and related information between health care providers and insurers. The first draft of this work is nearing completion with the release of the first Financial Standard for Trial Use in STU4 of FHIR. Over the next year further refinements will be expected as implementers begin developing regional profiles and begin live pilots with resources.
Once the above is well underway FM can then look to developing the Enrollment-related resources and the resources to support the FIAB functions.
3/21/2023 - change to:
FM has been focusing for R5 on the resources required to support the exchange of claims and related information between health care providers and insurers and the payment-related resources (PaymentNotice and PaymentReconciliation). Further effort is required to correct and mature the terminologies used in the financial resources.
Additionally FM can consider developing the Enrollment-related resources and the resources to support the FIAB functions.
https://jira.hl7.org/browse/FHIR-40659 - Update FM Module Roadmap
(1507) #EDI X12 to FHIR Conversion - FHIR Community - Zulip
Andy, Celine, and MK Terms end 12/31/2023
challenge: what is the correct payer/plan and how do we determine (define). No national source for a plan identifier
On the national level, national standard and there is only 1 instance. can always look it up.
Today there is no unique identifier for the payer/provider. There is no standard.
The system becomes the national directory. Becomes the national assigner of identities.
NAIC, is it unique? NAIC calls it a producer id. Producer Database (PDB) | NIPR
No national payer database
Digital Certificate ID - what happens when a new cert is issued?
Da Vinci - Risk-Based Lists
4th Meeting of the month Agenda (regularly), 10-15 minutes for Risk-Based Lists:
Risk Adjustment - Da Vinci - Confluence (hl7.org)
PSS: PSS for Risk Based Contract Member Identification (Updated) - Financial Management - Confluence (hl7.org)
Tickets to review for R5 - QA Updates
Paul will followup on the following:
VOCABULARY: New Code System needed for Surface Codes:
Existing: HL7.TERMINOLOGY\Surface Codes - FHIR v4.0.1
CREATE a new Code System
2. Create a US value set that inclues all except the "V"
3. Create a FDI value set that inclues all except the "F"
4. The existing code system will then be deprecated
5. will there need to be a naming system entry created? Question for Vocab
Create new Value Sets:
existing EXAMPLE VS: HL7.TERMINOLOGY\Surface Codes - FHIR v4.0.1 URL: http://terminology.hl7.org/ValueSet/surface urn:oid:2.16.840.1.113883.4.642.3.546
From ADA Standard No 1084_May2019.pdf: Surface Code (2.16.840.1.113883.4.642.1.316)
From the OID registry:
From the new V2+ web version:
HL7.TERMINOLOGY\bodySiteModifier - FHIR v4.0.1 Official URL: http://terminology.hl7.org/CodeSystem/v2-0495
See FHIR-33202. Another ADA code system (tooth identifying system). Add to THO
Jeff reaching out to Rick for an update.
Paul - we can do a better job for example codesets, especially in places where each country may have their own codeset. (IE Billing codes) where the codesets can vary widely.
We are working on value sets in improving definitions for interoperability. Targetting R6 for that cleanup.
VOCABULARY UPDATES: Coverage.type
Replacing the v3 ActCoverageTypeCode Value Set
***We have SEVERAL R5 tickets around this value set: 13024, 14127, 24916, 20361 (these are linked and in FMWG-Discussion Grouping)
C/N Working List of Definitions - Financial Management - Confluence (hl7.org)
See also JAN WGM work: 2022 01 20 Thurs Q3 - FM WGM Minutes - Financial Management - Confluence (hl7.org)
R5 Work - Clarification ADJ Category vs. ADJ Reason... what is the difference between Category and Reason use
PaymentReconciliation - add a ticket to request documentation addition to describe how to do a refund.
Category = Large Bucket
Reason = further description of why something ended up in the bucket
Category: Patient Responsibility / Reason: Deductible / Amount: 256.00
Category: Patient Responsibility / Reason: Co-Pay Amount / Amount: xx.xx
Category: Patient Responsibility / Reason: Co-Insurance Amount / Amount: xx.xx / Value: .20
Category: Patient Responsibility / Reason: Non-Par Provider
Category: Contractual / Reason: exceeds fee schedule / Amount: 27.00
Category: Contractual / Reason: exceeds plan contractual / Amount / 98.00
Category: Contractual / Reason: POS step down amount / Amount: 11.00
Category: Other / Reason: Tax Not Covered / Amount: 33.45
Category: Other / Reason:
Category: Constractual / Reason: exact dup claim/service
Category: Payer Initiated Reductions / Reason: Performance program proficiency requirements not met / Amount
01-Nov-22: The US has unique requirements. There's a desire to see how we can synchronize international code usage, as much as possible.
There are also situations where different jurisdictions have elements with the same name, but different meaninging.
supportingInfo Slices in existing IGs:
Do we need to add any of these to the base?
01-Nov-22: We might add to base is to guide IG authors in the best practice for adding this data.
CARIN made the design desicion to NOT use any extensions, and so they are using supportingInfo slices. Other IGs are using extensions for the same data elements. We'd like to simplify this for implementers with a standard.
|Patient/Related Person||Patient vs Related Person.pptx|
HL7 Antitrust Policy - Updated 10/2021
HL7 Code of Conduct
HL7 is a community where we can always ask searching questions about technical matters and how our decisions might impact our various communities and stakeholders, but HL7 and its participants are committed to a harassment-free environment for everyone, regardless of level of experience, professional background, gender, gender identity and expression, sexual orientation, disability, personal appearance, body size, race, ethnicity, age, religion, or nationality. Generally this should mean there is no reason for those subjects to come up with regard to any specific individual.
Co-chairs are asking our WG participants periodically review the HL7 Code of Conduct .
Human Services WG:
3/29/2022: Motion that FM be a co-sponsor. Approved. 16-0-0
Withdrawn (FM was sponsoring):
Meeting ID : 820 3100 5986 Topic : FM Full WG Weekly Conference Call User Email : firstname.lastname@example.org Duration (Minutes) : 111
Start Time : 2023-03-14 11:00:21 AM End Time : 2023-03-14 12:50:27 PM Participants : 20
|Name (Original Name)||User Email||Join Time||Leave Time||Duration|
|Guest||In Waiting Room|
RachelFoerster (RFA Ltd)
|2023-03-14 11:00:21 AM||2023-03-14 12:49:29 PM||110||Yes||No|
Jeff Brown (Lantana)
|2023-03-14 11:00:32 AM||2023-03-14 11:56:29 AM||56||Yes||No|
Benji Graham (HCSC)
|2023-03-14 11:00:42 AM||2023-03-14 11:30:53 AM||31||Yes||No|
MaryKay McDaniel (Financial Management Work Group)
|2023-03-14 11:00:52 AM||2023-03-14 12:50:26 PM||110||No||No|
Susan L Langford (BCBST)
|2023-03-14 11:00:55 AM||2023-03-14 12:50:26 PM||110||Yes||No|
Rita Torkzadeh (AEGIS.net)
|2023-03-14 11:01:20 AM||2023-03-14 12:12:26 PM||72||Yes||No|
Carie Hammond# AEGIS
|2023-03-14 11:01:41 AM||2023-03-14 12:49:16 PM||108||Yes||No|
|2023-03-14 11:01:56 AM||2023-03-14 11:07:52 AM||6||Yes||No|
|2023-03-14 11:02:04 AM||2023-03-14 12:50:26 PM||109||Yes||No|
|2023-03-14 11:02:32 AM||2023-03-14 12:50:26 PM||108||Yes||No|
|2023-03-14 11:02:33 AM||2023-03-14 11:26:30 AM||24||Yes||No|
|2023-03-14 11:02:33 AM||2023-03-14 12:50:26 PM||108||Yes||No|
|2023-03-14 11:02:44 AM||2023-03-14 12:38:59 PM||97||Yes||No|
|2023-03-14 11:05:27 AM||2023-03-14 11:30:02 AM||25||Yes||No|
|2023-03-14 11:09:11 AM||2023-03-14 11:49:29 AM||41||Yes||No|
Chris Johnson - BCBSAL
|2023-03-14 11:39:06 AM||2023-03-14 12:40:38 PM||62||Yes||No|
|2023-03-14 11:50:35 AM||2023-03-14 12:39:00 PM||49||Yes||No|
|2023-03-14 11:57:45 AM||2023-03-14 12:02:34 PM||5||Yes||No|
|2023-03-14 12:04:11 PM||2023-03-14 12:38:58 PM||35||Yes||No|
|2023-03-14 12:09:08 PM||2023-03-14 12:50:29 PM||42||No||No|