Agenda:

Remember the Antitrust Statement, see above

• Review/Approve 3/14/2023 Interim Meeting Minutes
• Announcements - see announcements row below
• https://jira.hl7.org/browse/FHIR-40279
• Da Vinci -
  • Payer Identifier Discussion (cont?)
• Review applied R5 tickets, QA Updates
• Review FMM for FM Resources
• May WGM Agenda
• V2 to FHIR Maps
• THO Terminology changes
• Additional items???
  • R5 - need to reword the roadmap section
  • Zulip thread X12 - FHIR mapping  (1507) #EDI X12 to FHIR Conversion - FHIR Community - Zulip
  • Co-Chair Elections 

2/28/2023:

V2 to FHIR Mapping Review/Updates. 

OO:  2-To-FHIR Project - Orders & Observations - Confluence (hl7.org)

• Kathleen was monitoring the work
• see:  2023-02-06-09 v2-FHIR - Orders & Observations - Confluence (hl7.org)
• see also:  Segment Mapping - Orders & Observations - Confluence (hl7.org)
• spreadsheets:  

3/21/2023

• Discussion of the may WGM agenda
• Only co-chairs at WGM will be Paul, Celine, Jeff
• Added Chair and Scribes to the 4 sessions FM will be meeting 
  • MQ4, WQ4, ThuQ1, FQ2
  • Joining PA ThuQ2
  • Joining OO ThuQ1

Weekly Call Minutes

Review & Approve Interim Meeting 3/14/2023

Change PMM to FMM

Accepted with the change above.

ANNOUNCEMENTS

• • Monthly Reminders to Co-Chairs:
    • Standards approaching expiration: 
      • https://confluence.hl7.org/display/HL7/ANSI+Standards+approaching+expiration
    • STUs Expiring in the Next 6 Months
      • https://confluence.hl7.org/display/HL7/STUs+Expiring+in+Next+6+Months
  • Upcoming PSS and NIB Deadline Dates for Future Ballot Cycles
    • All deadline dates can be seen on the new Balloting, Content Submission, Voting, and Working Group Meeting Schedules on Confluence at:
    • https://confluence.hl7.org/display/HL7/HL7+Calendars

• Next Call 3/28/2023
• FM Co-Chair calls:
  • NEXT Co-Chair Call - 3/21/2023

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

• https://jira.hl7.org/browse/FHIR-40279

3/21/2023. 

• https://jira.hl7.org/browse/FHIR-40279
• Persuasive with Mod. Remove Person
• Motion to approve. MaryKay McDaniel / Jeff Brown 5-0-0

R5 - need to reword the roadmap section

currently:

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
Financial Claims and Reimbursement (FICR) - insurance information, enrollment, eligibility, predetermination, preauthorization, claims, patient reporting and payments.

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 

• persuasive
• Motion to approve. MaryKay McDaniel/Mark Scrimshire : 5-0-0

Zulip thread...

(1507) #EDI X12 to FHIR Conversion - FHIR Community - Zulip

3/21/2023.

WG Co-Chair

Andy, Celine, and MK Terms end 12/31/2023

Da Vinci

• Payer Identifier Discussion

2/21/2022:

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

2/28/2023.

• build.fhir.org/diff.html will get you to a differential page.
• QA'd the changes made, notes in-line of the tickets. 

Paul will followup on the following:

• FHIR-31061    Add a resource level error.
  • 12/6/2022. RE-Open Ticket to remove, "Add a resource level error for an error that applies to the overall resource."
  • Motion to re-open. Chris Cioffi / Jeff Brown. 8-0-0
  • Remove the 1st disposition, "Add a resource level error for an error that applies to the overall resource."  Leaving the rest of the disposition
  • Motion to approve the new disposition. Chris Cioffi / Mary Kay McDaniel. 7-0-2
  • Will update
  • 2/24/2023. Complete - applied
  • 2/28/2023. QA'd. 
    • on claim response and eligibility response - NOT on EOB
    • Complete error structure needs to be added on the EOB Resource!!!!
• FHIR-22689. Claim.provider definition is confusing.
  • Will apply the change
  • 2/24/2023. Complete - applied
  • 2/28/2023. QA'd. Resolution = Applied
    • changed to ClaimResponse.requestor (there isn't a provider here, but the words were the same and therefore changed)
    • CoverageEligibilityResponse.requestor did not get changed. Paul will update. 
• FHIR-38627 [FHIR-38627] Clarify use of Coverage.subscriber - Jira (hl7.org)
  • 14-Feb-23 - resolution previously approved
  • 2/24/2023. Complete - applied
  • 2/28/2023. QA'd. Resolution = Applied
  • Need to fix: in comments "not" needs to be no
  • 
• FHIR-31368    Add guarantor responsibility and related elements to Account
  
  • From SEP 2022 WGM Meeting minutes: FHIR-31368 - Add elements to Account - will discuss in Q1 on Thursday, needs a vote.  Approved 11 Oct 2022 
  • 14-Feb-23 - Waiting for this to be applied
  • 2/28/2023. Changes were not applied
  • Paul will check to see if it can be added in QA period
• FHIR-38895  :  Missing invariants from ticket 32076
  • 14-Feb-23 - waiting to be applied
  • 2/28/2023. Technical error. will deal with it in QA 

14-Mar-23

• R5 targetted tickets did not all get applied
• We are pulling out what didn't happen
• Q: Are resources at FMM 0 going to move forward?
  • A: (PK) Removed from the pub kept in cont build
• Q: Part of PMM3 is talking about number of tickets, is that a hard requirment?

• Review of FM owned R5 resources to determine if we need/want to change their ranking in the FMM
  • Account 
    • Question for Paul for FMG: Account is heavily used, we would like to move to FMM3, but without 10 distinct comments we don't meet the requirement. Do we really need more comments or can the known heavy use still allow us to move forward?
    • We had 1 big ticket that could have been broken into several comments.
  • Contract
    • We have outstanding changes, that simply weren't applied
  • Coverage
    • MK thinks Coverage can move up to 3, no disagreements
  • CoverageEligibilityRequest & CoverageEligibilityResponse
    • We couldn't identify that these resources are used
  • EnrollmentRequest & EnrollmentResponse
    • Unable to find a current use of these resources
  • VisionPrescription
    • Likely being moved to another workgroup
  • Claim, Claimresponse, EOB, Payment Recon, PaymentNotice all to FMG 3

VOCABULARY:    New Code System needed for Surface Codes: 

Existing:  HL7.TERMINOLOGY\Surface Codes - FHIR v4.0.1

CREATE a new Code System

• FHIR-34221
  • 12/6/2022. THO changes. 
  • The value set is an example value set
  • Must go through THO

1. Create a new code system

• • • with the values below and add F, Facial, The surface of a tooth facing the lips.
    • Yes there are 2 codes with the same definition. F is used in the US only, V is used in all other countries.
      • Countries that follow ISO or FDI use "V"
      • 

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

• • research OIDS
    • http://terminology.hl7.org/CodeSystem/FDI-surface  OID is:  urn:oid:2.16.840.1.113883.4.642.1.1154

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

11/1/2022:

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

Steps: 

• Review each resource (alphabetically)
• Identify each vocabulary that needs to be updated

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)

VOCABULARY:  General

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.

6/28/2022: 

Category = Large Bucket

Reason = further description of why something ended up in the bucket

Potential EXAMPLES:

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:

CARINBB:

• Billingnetworkcontractingstatus
• admissionperiod
• clmrecvdate
• typeofbill
• pointoforigin
• admtype
• discharge-status
• drg
• medicalrecordnumber
• patientaccountnumber
• benefitpaymentstatus
• dayssupply
• dawcode
• refillNum
• refillsAuthorized
• brandgenericindicator
• rxoriginCode
• compoundcode
• performingnetworkcontractingstatus
• servicefacility

PAS:

• PatientEvent
• AdmissionDates
• DischargeDates
• AdditionalInformation
• MessageText
• InstitutionalEncounter (information about a hospital claim being requested)

VA:

• Initial Placement (dental claim)

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.

HL7 Antitrust Policy - Updated 10/2021

• The HL7 Antitrust Policy was approved as part of the last GOM Revision
  • Section 05 Antitrust Compliance
• The following statement must be added to the minutes for each meeting:
  • Professional Associations, such as HL7, which brihng together competing entities are subject to strict scrutiny under applicable antitrust laws. HL7 recognizes that the antitrust lawas were enacted to promote fairness in completion and, as such, supports laws agains monoploy 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).
• Co-Chair Handbook has been updated:  Co-Chair Handbook - Co-Chair Handbook - Confluence (hl7.org)

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 .

FM Co-Sponsoring:

Human Services WG:

• Project Proposal review:  [PSS-2000] FHIR IG for the Human Service Resource and Provider Directories - Jira (hl7.org)

3/29/2022:   Motion that FM be a co-sponsor.   Approved. 16-0-0

Da Vinci:

• Burden Reduction IGs - CRD STU2 - 
  • FM Primary Sponsor
• Burden Reduction IGs – PAS STU2 
  • • FM Primary Sponsor
• PDex STU2
  • FM Primary Sponsor
• Patient List
  • FM Sponsor
  • Risk Adjustment - Da Vinci - Confluence (hl7.org)
  • PSS:  PSS for Risk Based Contract Member Identification (Updated) - Financial Management - Confluence (hl7.org)
• National Directory (we are co-sponsors):  HL7.FHIR.US.FHIR-DIRECTORY-EXCHANGE\Home - FHIR v4.0.1
  • PA Sponsor
  • FM/PIE Co-sponsors

Primary Sponsor:

• KSA
• DV CRD
• DV PAS
• DV PDex
• DV Patient Cost Transparency 
• DV PCDE
• DV Member Attribution
• DV Plan Net
• CARIN for Blue Button

Co-Sponsor:

• National Directory (w/ PA)
• Gender Harmony (w/Vocabulary)
• CARIN Digital ID Card (w/PIE)
• DAM UDI (w/O&O)
• Validated Healthcare Directory R1 (w/PA)
• Human Service Resource and Provider Directories (w/Human Resources)

Withdrawn (FM was sponsoring):

• V3 Accounting & Billing R2
• V3 Claims and Reimbursement R4

Miscellaneous

• Uniform Elements for Prior Authorization