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Present

Name

Affiliation

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Robert DieterleEnablecare
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Stratametrics
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Nita ThingalayaIBC
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Cambia Health Solutions
  •   
Duane WalkerBCBSM
  •   
Gregory MagazuCaseNet
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Jeanie SmithBCBSFL
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Corey SpearsInfor
  •   
Greg Linden
  •   
Joseph QuinnOptum
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Ashley SteddingCMS
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Barbara AntunaAIM Specialty Health/ Anthem
  •   
Mary Kay McDanielCognosante
  •   
Michael GouldIBC
  •   
Laurie BurckhardtWPS Health Systems
  •   
Serafina Versaggi
  •   
Sreenivas MallipeddiMCG Health
  •   
Susan BellileAvaility
  •   
Susan LangfordBCBST
  •   
Taha AnjarwallaCAQH
  •   
Tony BensonBCBSAL
  •   
Tracey McCutcheonKPMG
  •   
Brent WoodmanBCBSM
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Sonja ZieglerOptum
  •   
Dawn Perreault
  •   
CMS
  •   
Anupam ThakurBCBS FL
  •   
Anthem
  •   
Jeffrey DanfordAllscripts



Column


Present

Name

Affiliation

  •   
John BialowiczBCBSM
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Nandini GangulyScope Info Tech/ EMDI
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Peter Muir
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Pallavi TalekarScope Info Tech
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Julia SkapikCognitive Medicine
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Kelly TaylorCMS
  •   
Karen L. Zapata Anthem
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Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Ballot and Connectathon Schedule
  • Jacksonville Connectathon - May 29-30
  • Goal is to ballot for September ballot cycle
    • Jun 30th -- NIB
    • Jul  14rd – Initial content
    • Jul 21st - Ballot Review Period Starts
    • Aug 4th – Final content
    • July 8th - Ballot sign up starts
    • Aug 9th – ballot voting starts
  • HL7 Atlanta Connectathon - end of September


Jacksonville Discovery Session
  • Topics discussed in Jacksonville:
    • Drivers
    • In Scope
    • Out of scope
    • Scenarios
      • Primary: Member moves from one covered plan to another covered plan, and requests transfer of data from old plan to new plan
      • Member and dependents move
      • Dependent only move
      • Legal representative authorized member data exchange
      • Member moves from covered plan to non-covered plan or from non-covered plan to covered plan
      • Break in qualified plan (e.g., MA-FFS-MA)
      • Member adds coverage
      • Etc.
    • Scenario Workflow
      • Member moves to new covered payer
      • Member authorizes new payer to receive decision records from old payer
      • New payer requests data from old payer
      • Old payer "sends" payload to new payer
      • New payer receives data
    • Patient Authorization Workflow
      • Assumption re: member still having access to old payer portal - typically terminated when member is no longer covered
      • Add Assumption: new payer has integrated with old payer?
        • New payer app has to be registered with old payer
        • Example: New payer portal has an option to request data from prior payer
          • List of apps integrated and approved
          • Process like Apple, Blue Button - sign onto your old portal and authorize that application for the new payer to get your data
      • Member-directed/authorized exchange
      • Prior Authorization from old payer doesn't have to become active for the new payer - the information just needs to be shared so they know that one existed, and don't have to ask the provider for the same information again
    • Information requirements - information exchanged between payers
    • Data elements
    • Encoding guidelines
      • Limiting scope to guidelines that can be electronically referenced
    • Was there conversation re: payer 1 sending medical records to payer 2?  Or no medical records, just data?
      • With member-directed exchange based on current NPRM, data is part of USCDI and would be exchanged based on a document reference (to exchange any aggregated sets of data)
      • Just the data that's needed that's relevant to the particular active treatment or approval/decision
    • Follow Up Actions
    • Parking Lot Items
    • Create 3 clinical scenarios that we could use to look at the data elements/information requirements
      • Example of patient with respiratory condition and need for oxygen
      • Diabetes, requiring ongoing medical supplies
      • Transplant patient - multiple medical needs with ongoing payer case management
    • Partipant request to share workflow/data examples
  • Content will be posted to Confluence 

ManagementNext agendaDiscuss 3 clinical scenarios proposed as examples
 Adjournment
Adjourned at 2:51pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval

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