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Attendees

Present

Name

Affiliation

X

Jean Narcisi


XRachel Foerster
XSusan Langford

Laurie Burckhardt
XGreg Zeller

Mary Lynn Bushman

Jeff Brown

Lorraine Doo

Sonya May

Sherry Wilson

Mike Denison

Lisa Nelson

Durwin Day
XLaurie Darst
XMark Krebs
XAmol Vyas
XTony Benson
XPaul Knapp
XReed Gelzer
XGail Kocher
XMaryKay McDaniel
XBob Dieterle
XPat Taylor


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link
CARIN BB open issues
  • Overarching IG Challenges ( need Pat Taylor on call to discuss)
      1 )
        • There have been 4 major issues coming from the CARIN BB effort that we're looking to bring to resolution
      3 )
      1. Beneficiary/Dependents. Subscriber vs. Beneficiary. All Member Identifiers
        • ID - Local to the resource creator
        • IDENTIFIER - an identifier everyone recognizes. Independent of where the information is created or by whom

      2 ) Secondary Insurance implications 

        • Developers are generally familiar with data from providers, not data from payers.
        • There are challenges in conveying the definitions of the notion of Subscriber vs. Beneficiary vs. a "Proxy" (e.g., child looking after an elderly parent)
      1. Secondary Insurance implications
      2. Search criteria across IGs. US CORE vs. DV needs
        4 )
          • Searches for data from a provider will be different for searches for data from a Payer
            • Searching for data from a payer generally need to be based on a Subscriber ID, not a patient identifier
        1. Overlaps of claim vs. clinical - Code set mismatches. Different use cases, different code sets. I.e., Pharmacy information NDC vs.
        RXNorm
        1. RxNorm vs. HCPCS or ICD vs. SNOMED
          • Payer financial data is generally governed by CMS/X12 and uses different value sets from clinical environments
          • We performed an analysis against the US Core codesets and found variances to what payers need
          • Additionally there are licensing obstacles for some code systems
          • New CMS Interoperability Rule requiring claims data be accessible to patient adds to the challenges resulting from these code set mismatches

        Goal is for co-chairs and other key stakeholders to come together on 4/2 to discuss how we'll be chasing these issues to resolution.


      Coverage Nomenclature - Linda Michaelsen, Optum


      Cross Paradigm Storyboard - Payer Perspective, Value-Based Care

      1) Block vote to approve outstanding comments (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 32, 33, 35, 38, 39, 44, 45, 46, 47, 48, 49, 50, 51, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64).

      Ballotcomments_HL7_XPARADIGM_PAYER_SB_R1_I1_2018MAY64-LJ-LRN-20200316.xls


      2) Vote indicating the workgroup approves the comment spreadsheet as fully reconciled


      Planned votes for 4/14:

      1) Vote to approve publication request - draft publication request posted: Pub Request - HL7 Cross Paradigm Storyboard – Payer Perspective, Value Based Care

      ACTION: Russ to check with Lynn on the approval steps needed for publication (Steering Committees, Management Groups, etc.)


       Adjournment


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