Chair: Viet Nguyen, Yan Heras
Scribe: Phung Matthews
Minutes Approved as Presented
This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
Da Vinci FHIR Education and Implementation event
April 26th- April 30th
Last Day to Register April 22, 2021.
|HL7 Process Update|
Continue discussing Risk Adjustment Report data elements and structural requirements from Payer to Provider
Phase 1- really focusing from Payer to Provider.
Visual on data elements that may be required for the Payer to Provider report. Not intended to be what a report should look like.
Adding Member information, provider information, Risk adjustment model and version, clinical evaluation date, Historic conditions, suspected conditions (based on hierarchical structure)
Status- include confirmed or non-confirmed
Condition- mentioned previously it was important to capture diagnosis codes. For each condition, may have last date of service.
For each HCC code, have diagnosing provider, current provider and supporting evidence.
Suspected conditions- include supporting evidence for the condition
Provider element- how do you link the provider and member. Is the provider to be the PCP or attributed to member.
Business scenario added to confluence- for more examples
Plan- how is this being represented, as many plans can change at any time. Would you add the most recent plan?
Filtering on API- How common is it for providers to pass parameters for certain elements, so that the payer will need to expose it for query purposes?
Are there gaps on the actuarial models- based on real scenarios?
Clinical evaluation period- scenario is provider wants to get an HCC back on a specific period.
Revenue period- The year you are adjusting for payment. Is this appropriate term?
Run Out period- As long as you can know which gaps period it falls under then you may not need run out.
Does query need parameter for the calendar year? Ie last period or this period? As you may need to know if the diagnosis was made last year.
Note- Public calls for the Week of 4/26-4/30/21 will be cancelled due to Da Vinci Education Event.
|Adjournment||Adjourned at PM 4:02PM ET|
|BCBS Alabama||Thomson Kuhn|
|Providence St. Joseph||Patty Craig|
|Phranil Metha||Healow||Cigna Evernorth|
- Re-evaluate the name of this use case as "Risk Adjustment" does not define the payment aspect of the primary focus. Need to discuss with CQI WG as well.
- Add to Phase 2 - Ability to remove and provide a reason for status change. e.g. the patient no longer has the condition.
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