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Section


Column


Present

Name

Affiliation

  •   
Enablecare
  •   
Stratametrics
  •   
Point of Care Partners
  •   
BCBSAL
  •   

Emily Calvert

CMS
  •   

Erica Ross

CMS
  •   
HeatherAMA
  •   
Optum
  •   

Kelly Anderson

BCBSAL
  •   
InterSystems
  •   

Mark Mundt

InterSystems
  •   
Megan SoccorsoCigna
  •   

Mike Funk

Humana
  •   
Nancy SpectorAMA
  •   
Terry CunninghamAMA
  •   
Tori WillowsWellcare
  •   
BCBSFL
  •   
Aim/ Anthem
  •   

Marci Maisano

Cigna
  •   
Edifecs
  •   
Edifecs
  •   
United Healthcare
  •   
Anthem
  •   
Christy Dodson
  •   
BCBSAL
  •   
Laura Hoffman
  •   
WPS Health Solutions
  •   
Optum
  •   
Edifecs
  •   
CMS
  •   

  •   

  •   
Raj
  •   
Ray WilkersonScope Info Tech
  •   
BCBST
  •   
Taha AnjarwallaCAQH
  •   
Tom
  •   
Sonja Ziegler
  •   
Intersystems
  •   
Nandini GangulyEMDI/ Scope Info Tech
  •   
BCBSM
  •   
Kasi
  •   
EMDI Team
  •   
Anthem
  •   
Bart CarlsonAzuba
  •   
Cambia
  •   
Duane WalkerBCBSM
  •   
InterSystems
  •   
Tibco
  •   
Louis BedorCognosante
  •   
Anthem
  •   
CMS
  •   
CMS
  •   
IBC
  •   
Anthem
  •   
Rian
  •   
Palmetto gba
  •   
Sandeep
  •   
Sreekanth PuramMettle Solutions
  •   
Allscripts
  •   
James Gallagher Jr.Premera
  •   
Joseph Figueroa
  •   
Tony LittleOptum
  •   
Pallavi TalekarEMDI/ Scope Info Tech
  •   
Thomas KesslerCMS
  •   
Todd Omundson
  •   
ZeOmega
  •   
Emily TenEyckCAQH
  •   
Mark Taylor
  •  
Julia Skapik
  •  
Michael BrodyCME Online
  •  
Michcelle ZuttermanHumana



Column


Present

Name

Affiliation

  •   
Anthem
  •   
Rachel GoldsteinCAQH
  •   
Ralph Saint-PhardHealow
  •   
Susan LestinaAHA
  •   
Briana BarnesScope Info Tech
  •   
Cerner
  •   
Cassandra Bell
  •   
Deepthi ReddyMettle Solutions
  •   
Cognosante
  •   
Humana
  •   
Prashanth Golconda
  •   
Rajesh Godavarthi
  •   
Rim Cothren
  •   
Scott LawrenceCMS
  •   
Chris JonesHumana
  •   
Christina BorgLumeris
  •   
Julie MaasEMR Direct
  •   
Kathleen Connor
  •   
Matt ReidAMA
  •   
Mike BerkmanCoverMyMeds
  •   
Monse SerenilHumad
  •   
Rian RaineyCoverMyMeds
  •   
Sandra StuartKP
  •   
Sheryl TurneyAnthem
  •   
Wanda Govan-JenkinsHHS
  •   
Chris HutchinsonCoverMyMeds
  •   
Anna MeisheidCMS
  •   
Cyrus PeyrovianFastAuth
  •   
Janice BakosAetna
  •   
SureScripts
  •   
Gevity
  •   
Melanie JonesCMS
  •   
eClinicalWorks
  •   
Tammy SchreinerWPS Health Solutions
  •   
Amy PetersonHumana
  •   
Dave Trotter, MD
  •   
BCBSIL
  •   
Renee Fuller
  •   
Helina Gebremariam
  •   
Cambia
  •   
Intepro
  •   
Carradora
  •   

  •   

  •   
MaxMD
  •   
Cindy Monarch BCBSM
  •   
Dawn PerreaultBCBSM
  •   
Cognizant
  •   
Mitre
  •   

  •   
Missy BoserSurescripts
  •   
CAQH
  •   
Phranil MehtaeClinicalWorks
  •   
Dylan TuggleBCBST
  •   
JPSys
  •   
Mario JarrinChange Healthcare
  •   
Jim AdamsonArkansas Blue Cross
  •   
Brian PoteetBCBST
  •   
Tony LaurieNoridian
  •   
Optum
  •   
Bonnie SirottZeOmega
  •   
MCG
  •   
ESAC
  •   
Geeta KrishnanEdifecs
  •   
Katherine LuskChildrens
  •   
Michael NovalesBCBSIL
  •   
Tracey McCutcheonKPMG
  •  
Anupam ThakurBCBS FL
  •  
Cathy PlattnerKP
  •  
Srinivasarao Eadara
  •  
Availity




Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy



Milestones
  • Mitre will be developing Reference Implementation
  • Gevity/ Lloyd McKenzie will be lead to author Implementation Guide
  • Da Vinci Connectathon in Jacksonville, FL - May 29-30 - May Onsite Connecthon - Guidewell
  • Early ballot cycle schedule
    • NIB - May 19
    • Sign up for ballot opens - May 21
    • Initial content due - May 19
    • QA period - June 6
    • Final Content due - June 17
    • Ballot opens - June 21
    • Ballot closes - July 21
  • There's a possibility that we may push this IG to the September ballot instead of the early ballot cycle - we'll know more over the next couple of weeks


Survey update


Mapping update
  • Reviewed X12 278 loops/ segments - landing on the ones that need to be supported
  • There are a couple more that need to be supported
  • Attestation vs. structured data

    • There's something in between documented specific values for a lab test for example vs. a condition exists and there's accompanying information
    • From a commercial payer point of view, if only the ones with a specific diagnosis could be fully automated then most wouldn't be automated 
    • Tell me what's going on with the patient, and then let the payer rules engine make a determine based on that - this would support many real-time use cases
    • If it can be done in a questionnaire, great - it can also be done by accessing R4 US Core profiles on supported resources
  • X12 will make a common mapping available
  • Not available via HL7
  • Entire bundle of FHIR resources, including Prior Authorization profile on top of Claims, as well as Da VInci Coverage resource - base 64 encode it, and send the entire bundle via 275 BIN segment
    • Embed FHIR into CDA unstructured section? No - MIME type that allows for XML or JSON - this would require revision to CDA
  • Provider should be able to send 275 with CDA or FHIR bundle - Robert Dieterletalking to Division of National Standards
  • Technology between payers and providers already exists, but X12 278 is not widely adopted
  • What we're doing is compliant with current regulation and anticipated attachments rule
    • This could be implemented a different way, but wouldn't be consistent with current regulations
  • Da Vinci mapping will be done and then passed to X12
  • X12 gave specific project members permission to use TR3 to do the mapping, we're not able to discuss on the weekly conference call


WEDI Presentation
  • Reviewed Prior Authorization presentation done at WEDI
  • Robert Dieterle will ask WEDI if ok to post


Next agendaNext week's call is cancelled due to Da Vinci Connectathon and Working Sessions taking place in Jacksonville, FL May 29-31
 Adjournment
 Adjourned at at 4pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval

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