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Chair:  Paul    Scribe: Chris

Call Logistics: 

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Attendees - list maintained at the bottom of the meeting notes

Antitrust Statement (HL7 GOM §05.02):

Professional Associations, such as HL7, which bring together competing entities are subject to strict scrutiny under applicable antitrust laws. HL7 recognizes that the antitrust laws were enacted to promote fairness in competition and, as such, supports laws against monopoly 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). 

...

Agenda Item

Meeting Minutes from Discussion

Agenda:

Remember the Antitrust Statement, see above

  • Review/Approve 3/07/2023 Interim Meeting Minutes
  • Announcements - see announcements row below
  • Hosting OO to discuss Vision Prescription
  • Da Vinci -
    • Payer Identifier Discussion (cont?)
    • PAS Block Vote 14
  • Review applied R5 tickets, QA Updates
    • Review FMM for FM Resources
  • May WGM Agenda
  • V2 to FHIR Maps
  • THO Terminology changes
  • Additional items???


2/28/2023:

V2 to FHIR Mapping Review/Updates. 

OO:  2-To-FHIR Project - Orders & Observations - Confluence (hl7.org)

14-Mar-23

  • Discussion of the may WGM agenda

Weekly Call Minutes

Review & Approve Interim Meeting 3/07/2023

Mar-7 Minutes accepted by unanimous consent 

ANNOUNCEMENTS

  • Next Call 3/21/2023
  • FM Co-Chair calls:
    • NEXT Co-Chair Call - 3/20/2023


2023 May Ballot Cycle

2023MAY ,  Mar 31, 2023 - May 01, 2023


Review PSS for Adverse Event Clinical Research Implementation Guide

  • MK: not one we'd normally participate with
  • CC: Agree with MK
  • No one spoke up to say we should participate.

Vision Prescription Discussion with OO



14-Mar-23:

OO Reps: Lorraine & Marti

  • Paul wants OO to understand the business reasons for why it is structured the way it is
  • There is an FMG proposal to drop VisionPrescription and use DeviceRequest instead (FHIR-39279)
    • Marti does not agree that there are already examples for this
  • Marti: the issue is around customizing devices
  • There's a difference between the prescription and an order for eyewear
  • Can DeviceRequest handle the details from lenSpecification?
  • FM would like to be involved with any discussions in reviewing DeviceRequest to ensure that business issues are addressed
  • OO - will look to either put this on the May WGM agenda or setup a dedicated call to discuss
    • Tentatively setup for Friday Q1

Motion to move VisionPrescription from FM to OO for inclusion in R5 - Paul Knapp / Chris Johnson - 9 - 0 - 0

Paul will send notification to FMG


Da Vinci

  • Payer Identifier Discussion



2/21/2022:

challenge:  what is the correct payer/plan and how do we determine (define).  No national source for a plan identifier

On the national level, national standard and there is only 1 instance. can always look it up.

Today there is no unique identifier for the payer/provider. There is no standard. 

The system becomes the national directory. Becomes the national assigner of identities.

NAIC, is it unique? NAIC calls it a producer id.  Producer Database (PDB) | NIPR

No national payer database

Digital Certificate ID - what happens when a new cert is issued?


2/21/2022:

Bob putting out block votes tonight, please put on agenda for next week vote.


Da Vinci PAS Block Vote #14

PULLED:  FHIR-36167


The attached items are submitted for a block vote for the PAS IG. 

You may withdraw any item from the block vote by responding to this email with the specific Key for the item you wish to withdraw or do so on the FM WG call prior to the vote on 3/14/2022.

The following is a link to JIRA for block vote 14: https://jira.hl7.org/issues/?filter=20318

Block vote 14 contains 13 ballot comments.

Issue Type

Key

Resolution

Summary

Reporter

Change Request

FHIR-40512

Persuasive

Allow both person (practitioner) as well as Organization (non-person) in Claim.provider

Mike Denison

Change Request

FHIR-39750

Persuasive

Creat links to CDex for sending additional (pended) information

Eric Haas

Change Request

FHIR-36737

Not Persuasive with Modification

Practitioner.address description should reflect that it can contain service locations

Gunjit Chhatwal

Change Request

FHIR-36618

Persuasive

comment on X12 vs. HL7 mechanisms for changing request

Celine Lefebvre

Change Request

FHIR-36594

Persuasive with Modification

SHALL follow P&S in HRex

Celine Lefebvre

Change Request

FHIR-36593

Persuasive

review description of 3 guides

Celine Lefebvre

Change Request

FHIR-36587

Persuasive

revise list of methods to submit additional information

Celine Lefebvre

Change Request

FHIR-36570

Persuasive

need to urge payers to leverage all 3 guides to make PAS worthwhile for providers to implement

Celine Lefebvre

Change Request

FHIR-36485

Persuasive

Link from Claim.careteam.provider to Practitioner not sufficient

Sonja Ziegler

Change Request

FHIR-36322

Persuasive

Figure 2.4 - line out of bottom of box “(4) Present result of PA response to provider in workflow” should be labeled

Chris Cioffi

Change Request

PULLED from block vote

FHIR-36167

Not Persuasive

Meet regulatory requirements more narrowly, don't model FHIR after x12

Isaac Vetter

Change Request

FHIR-36115

Persuasive

PA Support Additional Doc Rqst Workflow Diagram shows 278 PWK on Inquiry

Andrew Barbieri

Change Request

FHIR-36113

Not Persuasive

PAS Claim Inquiry has Claim.extension:certificationType while PAS Claim/Update does not

Andrew Barbieri


14-Mar-23 discussion:

  • 13 total, 12 left
  • Closer look at FHIR-40512
  • Motion to approve blockvote 14 as submitted, except for FHIR-36167: Bob Dieterle / Rachel Foerster : 10 - 0 - 1

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 - QA Updates


2/28/2023.

Paul will followup on the following:

  • 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
    • 2/24/2023. Complete - applied
    • 2/28/2023. QA'd. 
      • on claim response and eligibility response - NOT on EOB
      • Complete error structure needs to be added on the EOB Resource!!!!
  • FHIR-22689. Claim.provider definition is confusing.
    • Will apply the change
    • 2/24/2023. Complete - applied
    • 2/28/2023. QA'd. Resolution = Applied
      • changed to ClaimResponse.requestor (there isn't a provider here, but the words were the same and therefore changed)
      • CoverageEligibilityResponse.requestor did not get changed. Paul will update. 
  • FHIR-38627 [FHIR-38627] Clarify use of Coverage.subscriber - Jira (hl7.org)
    • 14-Feb-23 - resolution previously approved
    • 2/24/2023. Complete - applied
    • 2/28/2023. QA'd. Resolution = Applied
    • Need to fix: in comments "not" needs to be no
  • 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  
    • 14-Feb-23 - Waiting for this to be applied
    • 2/28/2023. Changes were not applied
    • Paul will check to see if it can be added in QA period
  • FHIR-38895  :  Missing invariants from ticket 32076
    • 14-Feb-23 - waiting to be applied
    • 2/28/2023. Technical error. will deal with it in QA 

14-Mar-23

  • R5 targetted tickets did not all get applied
  • We are pulling out what didn't happen
  • Q: Are resources at FMM 0 going to move forward?
    • A: (PK) Removed from the pub kept in cont build
  • Q: Part of PMM3 is talking about number of tickets, is that a hard requirment?


  • Review of FM owned R5 resources to determine if we need/want to change their ranking in the FMM
    • Account 
      • Question for Paul for FMG: Account is heavily used, we would like to move to FMM3, but without 10 distinct comments we don't meet the requirement. Do we really need more comments or can the known heavy use still allow us to move forward?
      • We had 1 big ticket that could have been broken into several comments.
    • Contract
      • We have outstanding changes, that simply weren't applied
    • Coverage
      • MK thinks Coverage can move up to 3, no disagreements
    • CoverageEligibilityRequest & CoverageEligibilityResponse
      • We couldn't identify that these resources are used
    • EnrollmentRequest & EnrollmentResponse
      • Unable to find a current use of these resources
    • VisionPrescription
      • Likely being moved to another workgroup
    • Claim, Claimresponse, EOB, Payment Recon, PaymentNotice all to FMG 3

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


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 UPDATES:  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

ResourceElement PathChange RequiredDiscussion
Coverage.type
Currently CodeableConcept/Preferred with a bag of codes. Committee is reviewing whether to replace the bag with a more structured series of codes.

.statusnone

.kindnone

.relationshipnoneCurrently CodeableConcept/Extensible with a THO registered internationally applicable codes and a FHIR valueset.

.class.typenoneCurrently CodeableConcept/Extensible with a THO registered internationally applicable codes and a FHIR valueset.

.costToBeneficiary.typenoneCurrently CodeableConcept/Extensible with a THO registered internationally applicable codes and a FHIR valueset.

.costToBeneficiary.typediscuss whether we can define a base set of codes then either do so or create new example codesCurrent example code may not have appropriate rights to use.

.costToBeneficiary.network2nd Review of codes

Currently CodeableConcept/Example with a THO registered internationally applicable codes and a FHIR valueset.

Suggest binding=Extensible after second review of the codes.

1st review of codes on 2022-11-01


.costToBeneficiary.unit2nd Review of codes

Currently CodeableConcept/Example with a THO registered internationally applicable codes and a FHIR valueset.

Suggest binding=Extensible after second review of the codes.

1st review of codes on 2022-11-01


.costToBeneficiary.term2nd Review of codes

Currently CodeableConcept/Example with a THO registered internationally applicable codes and a FHIR valueset.

Suggest binding=Extensible after second review of the codes.

1st review of codes on 2022-11-01


.costToBeneficiary.exception.type2nd Review of codes

Currently CodeableConcept/Example with a THO registered internationally applicable codes and a FHIR valueset.

Suggest binding=Extensible after second review of the codes.

1st review of codes on 2022-11-01

CoverageEligibilityRequest.priority

needs motion

Keep the definition consistent across FM resources (Claim, ClaimResponse, EOB)

Currently CodeableConcept/Example with a THO registered internationally applicable codes and a FHIR valueset.

Suggest binding=Extensible after second review of the codes.


.purpose

11/8/2022

needs motion


Currently a code datatype and therefore a required binding.

Suggest changing the data type to CodeableConcept (Extensible) using the current codesystem and valueset.


.item.categoryneeds workReplace the existing example codes with a shorted, alphanumeric list of codes so that there is no confusion that these are someone's Service Type Codes or that the list is complete.

.item.productOrServiceneeds workExample codes need attribution or to be replaced with a different example set,.

.item.modifier
Consider renaming the codesystem and valueset to 'ex-'.

.item.diagnosisCodeableConceptnone
CoverageEligibilityResponse.statusnone

.purpose

11/8/2022

needs motion


Currently a code datatype and therefore a required binding.

Suggest changing the data type to CodeableConcept (Extensible) using the current codesystem and valueset.


.outcomenoneCurrently a code datatype and therefore a required binding.

.item.categoryneeds workReplace the existing example codes with a shorted, alphanumeric list of codes so that there is no confusion that these are someone's Service Type Codes or that the list is complete.

.item.productOrServiceneeds workExample codes need attribution or to be replaced with a different example set,.

.item.modifier
Consider renaming the codesystem and valueset to 'ex-'.





















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)





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.

Patient/Related PersonPatient vs Related Person.pptx


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:

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

Da Vinci:


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

FAQs - 

  • FHIR IG numbering
    • The HL7 version naming convention is: v.b.r
      v = published version number. Pre-publication v = 0, STU1 = 1, etc.
      b = ballot number for this version. balloted 1 time b = 1, etc.
      r = revision number. The IG team can use this as they wish.
  • ID vs. IDENTIFIER: ID - Local to the resource creator, IDENTIFIER - an identifier everyone recognizes. Independent of where the information is created or by whom


ATTENDEES:

Meeting ID : 820 3100 5986 Topic : FM Full WG Weekly Conference Call User Email : fm-cc@lists.hl7.org Duration (Minutes) : 111

Start Time : 2023-03-14 11:00:21 AM End Time : 2023-03-14 12:50:27 PM Participants : 20

Name (Original Name)User Email Join TimeLeave TimeDuration
(Minutes)
GuestIn Waiting Room

RachelFoerster (RFA Ltd)


2023-03-14 11:00:21 AM2023-03-14 12:49:29 PM110YesNo

Jeff Brown (Lantana)


2023-03-14 11:00:32 AM2023-03-14 11:56:29 AM56YesNo

Benji Graham (HCSC)


2023-03-14 11:00:42 AM2023-03-14 11:30:53 AM31YesNo

MaryKay McDaniel (Financial Management Work Group)

fm-cc@lists.hl7.org

2023-03-14 11:00:52 AM2023-03-14 12:50:26 PM110NoNo

Susan L Langford (BCBST)


2023-03-14 11:00:55 AM2023-03-14 12:50:26 PM110YesNo

Rita Torkzadeh (AEGIS.net)


2023-03-14 11:01:20 AM2023-03-14 12:12:26 PM72YesNo

Carie Hammond# AEGIS


2023-03-14 11:01:41 AM2023-03-14 12:49:16 PM108YesNo

Marti Velezis


2023-03-14 11:01:56 AM2023-03-14 11:07:52 AM6YesNo

Chris Cioffi


2023-03-14 11:02:04 AM2023-03-14 12:50:26 PM109YesNo

13017526698


2023-03-14 11:02:32 AM2023-03-14 12:50:26 PM108YesNo

Robert Dieterle


2023-03-14 11:02:33 AM2023-03-14 11:26:30 AM24YesNo

celine lefebvre


2023-03-14 11:02:33 AM2023-03-14 12:50:26 PM108YesNo

17033468484


2023-03-14 11:02:44 AM2023-03-14 12:38:59 PM97YesNo

Rick Duffy


2023-03-14 11:05:27 AM2023-03-14 11:30:02 AM25YesNo

Marti Velezis


2023-03-14 11:09:11 AM2023-03-14 11:49:29 AM41YesNo

Chris Johnson - BCBSAL


2023-03-14 11:39:06 AM2023-03-14 12:40:38 PM62YesNo

Marti Velezis


2023-03-14 11:50:35 AM2023-03-14 12:39:00 PM49YesNo

Lorraine's iPhone


2023-03-14 11:57:45 AM2023-03-14 12:02:34 PM5YesNo

Lorraine's iPhone


2023-03-14 12:04:11 PM2023-03-14 12:38:58 PM35YesNo

Paul Knapp

fm-cc@lists.hl7.org

2023-03-14 12:09:08 PM2023-03-14 12:50:29 PM42NoNo