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Section


Column


Present

Name

Affiliation

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

Emily Calvert

CMS
  •   

Erica Ross

CMS
  •   
Heather McComasAMA
  •   
Optum
  •   

Kelly Anderson

BCBSAL
  •   
InterSystems
  •   

Mark Mundt

InterSystems
  •   
Megan SoccorsoCigna
  •   

Mike Funk

Humana
  •   
Nancy SpectorAMA
  •   
Terrence 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
  •   

  •   
CAQH
  •   
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 SkapikCognitive Medicine
  •   
Michael BrodyCME Online
  •   
Michelle ZuttermanHumana
  •   
Surescripts
  •   
Laurie DarstMayo
  •   
Marianna SinghCAQH
  •   
Labcorp
  •   

  •   
Mariana SinghCAQH
  •   
Madhuri
  •   

  •   
Bob THompson
  •   
Ben LangleyMITRE
  •   
Michelle PriestAllscripts
  •   
Michael Hurley
  •   
Cedars-Sinai
  •   
Roland Gamache
  •   
Dave HCRT INC
  •   
Barbara WoodPNC
  •   

  •   
Padma KondaveetiMettles
  •   
Unknown User (meryl_bloomrosen)Premier
  •   
Cambia
  •   
Judy Williamson
  •  
Matthew Maurer
  •  
Smitha Harish
  •  
Troy BergstrandBC Idaho



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 GodavarthiMCG
  •   
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 FullerIBX
  •   
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 EadaraesMD
  •   
Availity
  •   
ZeOmega
  •   
Dennis ZanettiNantHealth
  •   
Haris BegCambia
  •   
Kishore MetlaMettle Solutions
  •   
Sunitha Godavarthi
  •   

  •   
C-HIT
  •   
SriniesMD
  •   
Anthem
  •   
Kumar SourabhGRSI
  •   
Julia ChanCW Global Consult
  •   
Ric LightHumana
  •   
UHC
  •   
Anil VezendlaMCG
  •   
Ken LordBook Zurman
  •   

  •   
Christopher GraconIndependent Health
  •   
Gary GryanMitre
  •   
Mitre
  •   
Marty StaszakVoluware
  •   
Stephen ReckfordGRSI
  •   
Joe HamiltonUnity Point
  •   

  •   
Dave Foster
  •   
Betty SullivanAllscripts
  •   
Cigna
  •   
Juzer KhorakiwallaUHC
  •   
Unknown User (patricekuppe)Surescripts
  •   
Express-Scripts
  •   
Celine LefebvreAMA
  •   
Eshaa DhalleClinicalWorks
  •   

  •   
Aakash DeliwalaeClinicalWorks
  •   
Chris JohnsonBCBSAL
  •   
Megan RileyMITRE
  •   

  •   
Crystal HyattTransunion
  •   
Epic
  •  
AEGIS
  •  
Evan CurrieBCBSM




Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Milestones
  • MITRE is Reference Implementation developer
  • Gevity/ Lloyd McKenzie is IG lead 


Connectathon Kick-offNext agenda Adjournment
  • Philadelphia Connectathon Hosted by Independence Blue Cross - December 11-12
  • ConnectathonBallot comment review
    • MITRE presented CRD/DTR/Prior Authorization Support track overview and demo of Reference Implementation
    • Presentation and recording to be posted
    • Gary P. Gryan and Robert Dieterle to connect and make a few corrections to Connectathon track presentation


    Ballot comment review
    • Transition to JIRA by Monday morning (11/18/19)
    • Gforge will be locked 8pm ET today (11/15/19)
    • If you already have Confluence or Gforge account, should be able to use existing account to access JIRA

    #24326

    #24327

    #24328

    • There's existing evidence that this is possible
      • A national payer indicated 80% real-time prior auth
      • They primarily get information via portals/278 transactions
    • Question answered

    #24329

    • CAQH/WEDI surveys, for 2018, fewer than 12% of prior authorizations are processed using 278 request/response

    #24330

    • Language has been reviewed by CMS
    • This page is informative/advisory, not normative
    • Implementers should consult full regulations

    #24331

    • Some EHRs have indicated they intend to implement this IG
    • Add language that payers have desire to consume content in FHIR format


    Next agenda

    Ballot comment review continued


     Adjournment

    Adjourned at 4:03pm ET


    Supporting Documents

    Outline Reference

    Supporting Document

    Minute Approval
    Connectathon Kick-Off Presentation and recordingPrior Authorization Support Draft Implementation Guidehttp://build.fhir.org/ig/HL7/davinci-pas/index.htmlpresentation and recording



    Tasks

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    •