Review agenda -

Remember the Antitrust Statement, see above

• • Review/Approve 2/07/2023 Interim Meeting Minutes
  • Announcements - See below
• • Da Vinci - Block Votes in flight - review 2/7/2023, Vote 2/14/2023 
    • PAS Block Vote 12 
    • PDex Block Vote 9
    • CRD Block Vote 13
  • PaymentNotice Resource -
    • Need to generalize some of the elements, for example provider may need be recipient or some other generalized name (new use cases are popping up)
  • Unapplied R5 tickets - 2/24/2023
• Additional items

Lisa thankful for new notary code. FM to make new UP ticket for moving new code forward.

Created UP-399

Voted to approve in 2/7 meeting.

For next week:  Bob would like to have discussion on a payer identifier. What do we do prior to the National Directory? Context is the US realm. bob will pull together a set of talking points. 

Agenda accepted by unanimous consent.

Weekly Call Minutes

Review & Approve Interim Meeting 2/7/2023

ANNOUNCEMENTS

• • Monthly Reminders to Co-Chairs:
    • Standards approaching expiration: 
      • https://confluence.hl7.org/display/HL7/ANSI+Standards+approaching+expiration
    • STUs Expiring in the Next 6 Months
      • https://confluence.hl7.org/display/HL7/STUs+Expiring+in+Next+6+Months
  • Upcoming PSS and NIB Deadline Dates for Future Ballot Cycles
    • All deadline dates can be seen on the new Balloting, Content Submission, Voting, and Working Group Meeting Schedules on Confluence at:
    • https://confluence.hl7.org/display/HL7/HL7+Calendars

• Next Call 2/21/2023
• FM Co-Chair calls:
  • NEXT Co-Chair Call - 2/20/2023

2/14/2023:  PSS Review:

[PSS-2158] Updated FHIR DME Orders Project - Jira (hl7.org)

• Started by CMS to assist with PA and claims
• Expanding scope, work approved

[PSS-2154] FHIR profile de-duplication/reduction coalition - Jira (hl7.org)

• Work to create process to reduce redundant extensions and profiles. (IE: we don't need 12 extensions for the same thing)
• We agree the work is valuable, not sure about who should own.

• Da Vinci - 
  • PDex Block Vote 9
    • Block Vote 9 has been posted to the FM listserv. It contains 12 ballot comments. Please indicated any ballot comments you wish to withdraw from the block vote prior to, or on, the FM call on 2/7/2023
      The following is a link to Block Vote 9: 

      Jira
      server Jira jqlQuery filter=20108 serverId 9b965702-34a7-3433-bf10-7f66fd69238c

  • CRD Block Vote 13
    • The following is a link to JIRA for CRD block vote 13: 

      Jira
      server Jira jqlQuery filter=20104 serverId 9b965702-34a7-3433-bf10-7f66fd69238c

       which will be voted on the FM WG call on 2/7/2023. Block vote 13 contains 6 ballot comments.
  • PAS Block Vote 12
    • Robert Dieterle9:07 AM  
    • PAS Block Vote 12 containing 35 tickets has been posted to the FM listserv. The vote will take place on 2/7/2023 FM call
    • The following is a link to JIRA for block vote 10: https://jira.hl7.org/issues/?filter=20107

2/7/2023

• Block Vote overviews:  Bob Dieterle, no comments after posting.
• The biggest item - Attachments
  • Process of publishing CDex
  • some of the information still in draft, we haven't had enough comments/testing
  • our expectation is that we wil review/update and approve as an STU update (take draft indicator off the items)
  • Tried testing most at last 2 connectathons. Looking to create another opportunity to test before May
  • Responses for PA NPRM due 3/1
  • Response for Attachments NPRM due 3/21

2/14/2023 - Block Votes

PDex block Vote 9 - 12 ballot comments

Motion to approve by Bob Dieterle / MayKay McDaniel: 8 0 0 APPROVED

CRD block vote 13 - 6 ballot comments

Motion to approve by Bob Dieterle / Jeff Brown - 8 0 0 APPROVED

PAS block vote 12 - 35 ballot comments

Motion to approve by 

Bob Dieterle / Jeff Brown - 8 0 0 APPROVED

Da Vinci - Risk-Based Lists

4th Meeting of the month Agenda (regularly), 10-15 minutes for Risk-Based Lists:  

Risk Adjustment - Da Vinci - Confluence (hl7.org)

PSS:  PSS for Risk Based Contract Member Identification (Updated) - Financial Management - Confluence (hl7.org)

Tickets to review for R5

These are the tickets from the 10/11/2022 call:  

Jira Filters: 

For Co-Chair Call:  

project = FHIR AND issuetype in ("Change Request", Comment, Question, "Technical Correction") AND  "Resolution Vote" is not empty AND Specification = "FHIR Core (FHIR) [FHIR-core]" AND "Work Group" = fm and status not in ("Applied")

Resume at 22763

Jira Filter:  Applied for R5 - Ballot

project = FHIR AND issuetype in ("Change Request", Comment, Question, "Technical Correction") AND status in (Applied) AND Specification = "FHIR Core (FHIR) [FHIR-core]" AND "Work Group" =

Needs Negative ballot vote

•  37594 
  • 12/6/2022. Reviewed, will update. DONE
•  34221
  • 12/6/2022. THO update, will not be done for R5. 
  • The value set is an example value set
  • Must go through THO
•  33244
  • 12/6/2022. Reviewed, approved, will update 
•  FHIR-32797    Add Trace Numbers to the base specification 
  • 12/6/2022. Reviewed, will update DONE
    
    • From SEP 2022 WGM Meeting minutes: FHIR-32797 - Add trace numbers to base specification - This is equivalent to the X12 TRN segment
•  

  FHIR-32776    Add more guidance on the expected use of adjudication and supportingInfo

  • 12/6/2022.  Reviewed, will update DONE
    • From SEP 2022 WGM Meeting minutes:  FHIR-32776 - Guidance for adjudication and supportingInfo - we want to do it as described in ticket
•  32075  Clarifing text between ClaimResponse.item, noteNumber and ClaimResponse.processNote
  • 12/6/2022. Reveiwed, will update. DONE
•  31678
  • 12/6/2022. Reviewed, will update.
•  

  FHIR-31062    Create a "Dates" Backbone element

  • 12/6/2022. Reviewed, will update
    • From SEP 2022 WGM Meeting minutes: FHIR-31062 - Create Dates backbone - looking for examples of what would be fixed with the proposed Dates backbone
•  FHIR-31061    Add a resource level error.
  • 12/6/2022. RE-Open Ticket to remove, "Add a resource level error for an error that applies to the overall resource."
  • Motion to re-open. Chris Cioffi / Jeff Brown. 8-0-0
  • Remove the 1st disposition, "Add a resource level error for an error that applies to the overall resource."  Leaving the rest of the disposition
  • Motion to approve the new disposition. Chris Cioffi / Mary Kay McDaniel. 7-0-2
  • Will update
•  30929 -   THO Update  Vocabulary Update Payee Type VS/CS
  • 12/6/2022. THO Update, will not be done for R5
•  FHIR-30502    THO Update. Add values to Code System Adjudication
  • 12/6/2022. THO Update, will not be done for R5

Start here 12/13/2022:  

•  29687. Add encounter 
  • 12/6/2022. Review next week. Encounter was already added, the words are different. 
  • 12/13/2022. "Medical encounters related to this claim" (29687).
    • The Spec currently says "The encounters during which this claim was created or to which the creation of this record is tightly associated."
    • 3 tickets to add encounter at the header:
      • this one FHIR-29687

      • Jira
        server Jira serverId 9b965702-34a7-3433-bf10-7f66fd69238c key FHIR-30337

      • Jira
        server Jira serverId 9b965702-34a7-3433-bf10-7f66fd69238c key FHIR-33201

        • Add to the header portion of Claim, ClaimResponse and ExplanationOfBenefit

          encounter 0..* Reference(Encounter) The encounters associated with the listed treatments

      • Re-opened FHIR-29687. Motion to re-open 29687. MaryKay McDaniel/Chris Cioffi. 8-0-0.
      • FHIR-29687 disposition is Persuasive with Modification, 
        • The .encounter 0..* Reference (Encounter) has been added under a previous ticket.
        • This ticket suggests a definition of:  Medical Encounters related to this Claim
        • The definition shall be amended to: Healthcare encounters related to this claim
        • The short description shall be amended to:  The encounters associated with the listed treatments
        • Motion to approve with the proposed disposition. Chris Cioffi/Mark Scrimshire. 8-0-0
•  

  FHIR-27109    Coverage.class value set needs to change "plan" to "benefit plan" - VOCAB UPDATE

  • From SEP 2022 WGM Meeting minutes:  FHIR-27109 - Change "Plan" to "Benefit Plan", not an FM ticket
  • 10/7/2022. This is an FM Ticket, it s a terminology change that needs to be made. Change to the display name. This is in THO, FM needs to create a ticket and make update. 
•  FHIR-23003. Remove IP covered codes - Revenue Codes & Present on Admission
  • Re-Open. To apply changes only to the the revenue code center . Motion to re-open. Mark Scrimshire/Chris Cioffi. 8-0-0.
  • New disposition will change the revenue codes and leave the present on admission codes as is. Both are example code systems.
  • Motion to approve, Persuasive with Modification. MaryKay McDaniel/Chris Cioffi 7-0-0.
•  FHIR-22763.  Remove invalid icd-10 code references for Claim in valueset-icd-10 and fix codes in related examples. 12/13/2022. MARKED AS CHANGE APPLIED.
  • ticket is marked as resolved - change required
  • Reviewed the code system and the examples. Unable to locate any changes needed.
  • Marked as applied. 
•  FHIR-22689. Claim.provider definition is confusing.
  • Will apply the change

2/7/2023:  the following tickets are complete with the exception of the code set/value system.

•  FHIR-32762. Add dates at the .item levels in Claim Respose and EOB. Listed as duplicate of 22662 another ticket. 

• • 1/10/2023. This is not a duplicate of 22662.  "unduplicated" the ticket. 
  • This is a partial duplicate of 22662. When adding the preAuthPeriod element from 32762, this request will be met.
  • Motion to approve. MaryKay McDaniel/Celine Lefebvre. 5-0-0
  • 2/7/2023. reviewOutcome, need new code system/value set for the .reviewOutcome.reason - we have an external code system but it is not in FHIR or in THO. because we can't, need to make one up. 

    • New example code system/ value set (see table to the left for code | display | description

      • Not medically necessary
      • Prior Authorization was not obtained
      • Provider out of network
      • Service inconsistent with patient age
      • Benefit limits exceeded
    • Paul will add the code system/value set to FHIR to complete these three tickets
  • 2/14/2023: Will add codes and descriptions to the above display values.

•  FHIR-22662. Need outcome/disposition/preAuthRef/preAuthPeriod on individual items
  • 12/13/2022. Paul will find competing ticket that added decision element - FHIR-37662 (which is marked as duplicate).
  • Need to go back and refresh.
  • 1/10/2023. 4 items to be added to ClaimResponse/EOB - outcome/disposition/preAuthRef/preAuthPeriod elements to be added at all the .xx levels
    • outcome - the outcome of the processing - The completeness of the processing. believe it should be decision instead (denied, pended, partial, approved) - decision is a perspective of the adjudication "the result of the adjudication"
    • disposition - human readable description of the adjudication status.
    • preAuthRef - at the 'header' level, move down to the .xx levels 
    • preAuthPeriod elements - at the 'header' level, move down to the .xx levels 
    • this ticket was voted 20-0-2, to open back up will take 13 people
    • add a new ticket FHIR-40082  Add cardinalities, value set and rename category to decision in .reviewOutcome
•  FHIR-40082. Add cardinalities, value set and rename category to decision in .reviewOutcome
  • motion to approve. MaryKay McDaniel/Celine Lefebvre. 5-0-0
•  This is Done....   Financial Management - 13.0.16 Terminology.

Currently: 

• • • In many cases an example valueset has been provided in this release. Financial Management will be devoting effort in the preparation to Release 5 of FHIR to develop more representative example sets and to determine where global codesets exist such that some of the valuesets may be elevated in strength to extensible or required.

Start here 2/7/2023:

•  Ticket for PaymentNotice:

• • • 2/7/2023: Chris Cioffi will create a ticket for all three of these changes 
      • Typo:  Add ticket to correct the description for .identifier, see last word
      • Payment becomes 0..1
      • There is no place to include the 'sender/reporter' on the PaymentNotice. Rename of the "provider field" to reporter. change description to 'entity reporting payment'

Start here 2/14/2023:

•  FHIR-22659. PA claims for procedures need a reference to a to a ServiceRequest
  • 1/10/2023:  add all "requests' at the .item level with instruction/discussion on put it there and not in .procedures (procedures can only be 'done' - see Procedure Resource).
    • Device Request
    • Medication Request
    • Nutrition Order
      • A request to supply a diet, formula feeding (enteral) or oral nutritional supplement to a patient/resident.
    • Service Request
      • A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.
    • Supply Request
      • The scope of the SupplyRequest resource is for recording the request of supplies used in the healthcare process. This includes supplies specifically used in the treatment of patients as well as supply movement within an institution (transport a set of supplies from materials management to a service unit (nurse station). This resource does not include the provisioning of transportation services
    • VisionPrescription Resource
  • 2/7/2023. Agreed, need to add. 
    • What would the element that is being added be named?????
    • In what resource are surgical procedures included?
  • 14-Feb-23: Added VisionPrescription
    • This is going to be put into the disposition
    • Motion to approve re-open this ticket and update the resolution
      • MaryKay McDaniel / Rachel Foerster - 7 0 0 APPROVED
•  [FHIR-37588] Add adjudication quantity to ClaimResponse & EOB - Jira (hl7.org)
  • Group suggested changing the datatype and the name of the existing value (decimal 0..1) to adjudication.quantity  0..1 to allow for the expression of units with a 'type' for clarity
  • description: Non-monetary amount
  • Non-persusuave, enhancement,
  • Motion to approve 37588: 
    • Chris Cioffi, Mark Scrimshire. 14-0-0
•  FHIR-38627 [FHIR-38627] Clarify use of Coverage.subscriber - Jira (hl7.org)

• • 14-Feb-23 - resolution previously approved

•   FHIR-31368    Add guarantor responsibility and related elements to Account
  
  • From SEP 2022 WGM Meeting minutes: FHIR-31368 - Add elements to Account - will discuss in Q1 on Thursday, needs a vote.  Approved 11 Oct 2022 
  • 14-Feb-23 - Waiting for this to be applied
•  FHIR-38895  :  Missing invariants from ticket 32076

• 14-Feb-23 - waiting to be applied

•  FHIR-38896:  Updates to Vocabulary. 

• • Revmove the self-pay code system
  • Change to VS Coverage Type and Self-Pay Codes - Update the Name and title to remove 'self-pay'
  • 14-Feb-23 - this needs to go through the UP process

•  [FHIR-37828] Add .payment backbone to .item (EOB) - Jira (hl7.org):  Need to review and approve in WG

• • 8/16/2022 FM Meeting minutes, FHIR-37828: Passed, too time consuming. If we have time will address 8/30.

  • 8/30/2022. Ran out of time
  • 10/11/2022: Ran out of time, add to ballot negative comment
  • 14-Feb-23:
    • There can be differences between benefit amount and payment amount
    • Ran out of time
    • Probably cannot get this in for R5, will create an extension in the interim

Need to create a ticket or negative ballot comment for this clarification:

R4 comments guidance and update for R5

ExplanationOfBenefit.created

Definition:  The date this resource was created

Requirements:  Need to record a timestamp for used by both the recipient and the issuer

• • • • the definition and the comments don't seem to make sense.
      • Is it the date the resource was created?

12/13/2022. 

FHIR 29687 Motion to edit to definition and change short description. Vote: Mary Kay/Chris Cioffi 8– 0–0

Link following three tickets - FHIR 33201, FHIR 30337, FHIR-29687 Vote: Chris Cioffi/Mark Scrimshire 8–0–0

FHIR 23003 Motion to change ex-revenue codes to be made up values to remove infringement. Vote: Chris Cioffi/Mark Scrimshire seconded 8–0–0. Then motion to change ticket to non substantive. Vote: Mary Kay/Chris Cioffi 7-0-0

FHIR 22763 – No objection to change as applied.

FHIR 22689 – No objection to change as applied.

FHIR 22662 – Already looked at this ticket and agreed to the change.  

FHIR 32762 (marked as duplicate of 22662 but that is not accurate)

1/10/2023.

Anyone in addition to Paul available to make changes to the standard?  Need 1) full build software on machine, 2) access to github and 3) know how to make the changes. 

• base changes made (spreadsheet and structure definitions)
• examples

What are the latest dates for R5?

• "release of R5" May 2023
• Whatever we have in by the end of March

SEE notes to the left for the tickets that were worked on under 1/10/2023 section.

2/7/2023, reviewed in call

See notes in-line to the left....

2/14/2023

14-Feb-23 -Chris still needs to create ticket 

14-Feb-23  - See notes inline

VOCABULARY:    New Code System needed for Surface Codes: 

Existing:  HL7.TERMINOLOGY\Surface Codes - FHIR v4.0.1

CREATE a new Code System

• FHIR-34221
  • 12/6/2022. THO changes. 
  • The value set is an example value set
  • Must go through THO

1. Create a new code system

• • • with the values below and add F, Facial, The surface of a tooth facing the lips.
    • Yes there are 2 codes with the same definition. F is used in the US only, V is used in all other countries.
      • Countries that follow ISO or FDI use "V"
      • 

2.  Create a US value set that inclues all except the "V"

3.  Create a FDI value set that inclues all except the "F"

4. The existing code system will then be deprecated

5. will there need to be a naming system entry created? Question for Vocab

• • research OIDS
    • http://terminology.hl7.org/CodeSystem/FDI-surface  OID is:  urn:oid:2.16.840.1.113883.4.642.1.1154

Create new Value Sets:

existing EXAMPLE VS:  HL7.TERMINOLOGY\Surface Codes - FHIR v4.0.1   URL:  http://terminology.hl7.org/ValueSet/surface  urn:oid:2.16.840.1.113883.4.642.3.546

From ADA Standard No 1084_May2019.pdf:   Surface Code (2.16.840.1.113883.4.642.1.316)

From the OID registry:  

From the new V2+ web version:

HL7.TERMINOLOGY\bodySiteModifier - FHIR v4.0.1  Official URL: http://terminology.hl7.org/CodeSystem/v2-0495

11/1/2022:

See FHIR-33202. Another ADA code system (tooth identifying system). Add to THO

Jeff reaching out to Rick for an update.

Paul - we can do a better job for example codesets, especially in places where each country may have their own codeset. (IE Billing codes) where the codesets can vary widely.

We are working on value sets in improving definitions for interoperability. Targetting R6 for that cleanup.

VOCABULARY:  Coverage.type

Steps: 

• Review each resource (alphabetically)
• Identify each vocabulary that needs to be updated

Replacing the v3 ActCoverageTypeCode Value Set

***We have SEVERAL R5 tickets around this value set:  13024, 14127, 24916, 20361  (these are linked and in FMWG-Discussion Grouping)

VOCABULARY:  General

C/N Working List of Definitions - Financial Management - Confluence (hl7.org)

See also JAN WGM work:  2022 01 20 Thurs Q3 - FM WGM Minutes - Financial Management - Confluence (hl7.org)

11/15/2022: FYI, 

R5 Work - Clarification ADJ Category vs. ADJ Reason... what is the difference between Category and Reason use

PaymentReconciliation - add a ticket to request documentation addition to describe how to do a refund.

6/28/2022: 

Category = Large Bucket

Reason = further description of why something ended up in the bucket

Potential EXAMPLES:

Category:  Patient Responsibility  / Reason:  Deductible / Amount:  256.00

Category:  Patient Responsibility / Reason: Co-Pay Amount / Amount: xx.xx

Category:  Patient Responsibility / Reason: Co-Insurance Amount / Amount: xx.xx / Value:  .20

Category:  Patient Responsibility / Reason: Non-Par Provider

Category:  Contractual / Reason: exceeds fee schedule / Amount: 27.00

Category: Contractual / Reason:  exceeds plan contractual / Amount / 98.00

Category:  Contractual / Reason: POS step down amount / Amount: 11.00

Category:  Other / Reason: Tax Not Covered / Amount: 33.45

Category:  Other / Reason: 

Category:  Constractual / Reason: exact dup claim/service 

Category:  Payer Initiated Reductions / Reason:  Performance program proficiency requirements not met / Amount

01-Nov-22: The US has unique requirements. There's a desire to see how we can synchronize international code usage, as much as possible.

There are also situations where different jurisdictions have elements with the same name, but different meaninging.

supportingInfo Slices in existing IGs:

CARINBB:

• Billingnetworkcontractingstatus
• admissionperiod
• clmrecvdate
• typeofbill
• pointoforigin
• admtype
• discharge-status
• drg
• medicalrecordnumber
• patientaccountnumber
• benefitpaymentstatus
• dayssupply
• dawcode
• refillNum
• refillsAuthorized
• brandgenericindicator
• rxoriginCode
• compoundcode
• performingnetworkcontractingstatus
• servicefacility

PAS:

• PatientEvent
• AdmissionDates
• DischargeDates
• AdditionalInformation
• MessageText
• InstitutionalEncounter (information about a hospital claim being requested)

VA:

• Initial Placement (dental claim)

Do we need to add any of these to the base?

01-Nov-22: We might add to base is to guide IG authors in the best practice for adding this data.

CARIN made the design desicion to NOT use any extensions, and so they are using supportingInfo slices. Other IGs are using extensions for the same data elements. We'd like to simplify this for implementers with a standard.

HL7 Antitrust Policy - Updated 10/2021

• The HL7 Antitrust Policy was approved as part of the last GOM Revision
  • Section 05 Antitrust Compliance
• The following statement must be added to the minutes for each meeting:
  • Professional Associations, such as HL7, which brihng together competing entities are subject to strict scrutiny under applicable antitrust laws. HL7 recognizes that the antitrust lawas were enacted to promote fairness in completion and, as such, supports laws agains monoploy and restraints of trade and their enforcement. Each individual participating in HL7 meetings and conferences, regardless of venue, is responsible for knowing the contents of and adhering to the HL7 Antitrust Policy as stated in 05.01 of the Governance and Operations Manual (GOM).
• Co-Chair Handbook has been updated:  Co-Chair Handbook - Co-Chair Handbook - Confluence (hl7.org)

HL7 Code of Conduct

HL7 is a community where we can always ask searching questions about technical matters and how our decisions might impact our various communities and stakeholders, but HL7 and its participants are committed to a harassment-free environment for everyone, regardless of level of experience, professional background, gender, gender identity and expression, sexual orientation, disability, personal appearance, body size, race, ethnicity, age, religion, or nationality. Generally this should mean there is no reason for those subjects to come up with regard to any specific individual.

Co-chairs are asking our WG participants periodically review the HL7 Code of Conduct .

FM Co-Sponsoring:

Human Services WG:

• Project Proposal review:  [PSS-2000] FHIR IG for the Human Service Resource and Provider Directories - Jira (hl7.org)

3/29/2022:   Motion that FM be a co-sponsor.   Approved. 16-0-0

Da Vinci:

• Burden Reduction IGs - CRD STU2 - 
  • FM Primary Sponsor
• Burden Reduction IGs – PAS STU2 
  • • FM Primary Sponsor
• PDex STU2
  • FM Primary Sponsor
• Patient List
  • FM Sponsor
  • Risk Adjustment - Da Vinci - Confluence (hl7.org)
  • PSS:  PSS for Risk Based Contract Member Identification (Updated) - Financial Management - Confluence (hl7.org)
• National Directory (we are co-sponsors):  HL7.FHIR.US.FHIR-DIRECTORY-EXCHANGE\Home - FHIR v4.0.1
  • PA Sponsor
  • FM/PIE Co-sponsors

Primary Sponsor:

• KSA
• DV CRD
• DV PAS
• DV PDex
• DV Patient Cost Transparency 
• DV PCDE
• DV Member Attribution
• DV Plan Net
• CARIN for Blue Button

Co-Sponsor:

• National Directory (w/ PA)
• Gender Harmony (w/Vocabulary)
• CARIN Digital ID Card (w/PIE)
• DAM UDI (w/O&O)
• Validated Healthcare Directory R1 (w/PA)
• Human Service Resource and Provider Directories (w/Human Resources)

Withdrawn (FM was sponsoring):

• V3 Accounting & Billing R2
• V3 Claims and Reimbursement R4

Miscellaneous

• Uniform Elements for Prior Authorization