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May 4



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Co-Chair Meeting

  • Confluence Updates needed:
    • FM main page not updated 
    • eVoting page, see Clinical SD for suggestions
  • Agenda
    • Goals for each quarter
    • documentation needed for each quarter

  • Confluence Updates needed:  Benoit will sit with Josh and do.
SundayMay 5AMQ1
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MondayMay 6AMQ1Salon A

Agenda/wk overview

Project detailing and alignment - Bob Dieterle  (What do we need to review in this WGM for the DV Project- MK/Paul)

C-CDA Payer Section, Linda M. Need to add to one of the joint session.  See:  Payer Section C-CDA - Wednesday Q1

FM has CRD ballot items that need final resolution, need to add to FM Agenda

GOAL: Finalize Agenda items and required participants for all quarters


Linda; 30-45 minutes on FM’s agenda during WGM to continue the discussion on CCDA Payer section.  I am not available

Monday Q1, Q2 or Q4.

I will be there through Q1 Thursday.

Approve 1489, 2 additional FHIR IGs - Drug formulary and Payer Network. 

Bob Dieterle - motion, Laurie Burkhardt 2nd. 23-0-1

Q2 Salon Musset

FM Administration


 Need to remove ARV segments in body of Chapt 6 .  Reference to Chapt 2 use of ARV manifest needs to be added to both Chapt 6 & 16.  We voted to do this during Jan 2019 ballot reconciliation.  See

Paul:  Motion, add discovered item to the 2.9 to fulfill the disposition item from the January Ballot item.  (technical correction to an item not previously addressed). The CTO will need to approve. 

Beat second.


View file
nameCopy of Ballotcomments_V29_R1_N4_2019JAN_amalgamated_2019025_BHE.xlsx

Bennoit volunteered to be the FM EST Liaison

Andrew Statler 4/26

Hello fellow Co-Chairs.

         I am reaching out to you again to ask that you please identify a Liaison for your Group as a contact point with the Electronic Services and Tools Workgroup. At present, we have Liaisons for the following Workgroups:

  • Structured Documents/CDAMG (Andrew Statler)
  • Imaging Integration (Luiza Kowalczyk)
  • Clinical Information Modeling Initiative (Richard R. Esmond)

The expectations for the liaison are minimal. We are mainly looking for a point of contact to push communications & updates about changes to Tooling and digital Service offerings that groups should be aware of. Not all groups use all tooling, but all groups do tend to leverage a few common tools like In the future, all groups may use JIRA as it may be the tool through which all help desk tickets are routed, so it may be necessary that every group be aware of the tool and how to use it.

There are a variety of tools out there and not every group uses every tool. We would like to establish a list of tools used by each group and so we would like a contact point that can help us discern what each group uses currently. This would help us target communications, help us provide better support for the tools we offer, deprecate tools that are no longer in use and repurpose those dollars to new or better tooling.

You can help in this effort by giving us a primary contact for this effort. It can be changed later, but we really need to make sure we have someone that we can work with at any given time. If they are unable to, they can go back to the group and ask the group to choose a new representative.

Most of the involvement will be push communications from EST to the liaison. From time-to-time we may send short surveys to the liaisons to update our information about your group. We also have a liaison session on Thursday during the WGM.

If you could take a moment to go to our Confluence Liaison Page link below and add a name for your working group, you can help us move tooling forward at HL7.

Updated the Mission & Charter. Approve updates made. Motion by:  MaryKay McDaniel, Second Laurie Burckhardt. 6-0-0.

Updated SWOT. Motion to approve updates made:  MaryKay McDaniel, Second Laurie Burckhardt. 7-0-0

PMQ3Salon Musset

FM Working: Dynamic Vocabulary and correct licensed vocab in FHIR

Examples include:

  • Identifiers ("code system". A=NPI, B=Inhouse, etc.)
  • NUBC - TOB, Revenue Codes, Condition Codes; NCPDP - DAW

GOAL: Plan/next steps for how to add the vocabulary to the base resource and/or the US profiles and/or make corrections in V2


***Prior to meeting, MK see HTA

1) V2 walk through the code sets to identify the infringement

2) how to specify vocabulary

**reviewed vocabulary needs for the US Realm work. Need to work with the Da Vinci developers to ask how they are going to be doing the mapping.

Q4Salon A

US Market Needs / Business Level Processing

Eligibility (Coverage Validation, Coverage Discovery, Benefits Determination), Prior Auth).  High level discussion, what are these things - what is the activity? Define the business intention/requirements.

GOAL:  Business level activity name definition and high level content for US provider/payer financial exchanges 


Who talks to who, when and why - Not the WHEN, the what

Activity diagram (steps)

See spreadsheet listed in Tuesday Q3.

TuesdayMay 7AMQ1
Not Meeting

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FHIR - Overview / Financial ResourcesAttachments

Request to FM WG:  ClaimResponse suggested-alternative Extension. Requestors will attend a Pharmacy WG session the WGM to discuss. Coordination may be needed with NCPDP. After meeting with PMG, will check back in with the FMWG.

Using notes from MQ4 (spreadsheet on Documentation page:  Financial Domain Activities 20190507.xlsx)

Paul gave an overview of how to read and understand the FHIR standard, then a walk through of the FM resources. 


Financial Resources

To address the Eligibility, Coverage Validation, Prior Auth

GOAL: from each US based activity, named and documented FHIR pattern


Continuation of Q3. Overview of the business activity and request/response resources.

There is no document that was completed. Attachment WG will complete tomorrow Q1/Q2.

WednesdayMay 8AMQ1

Rm 728

C-CDA Payer Section, Linda M. Need to add to one of the joint session.  See:  Payer Section C-CDA


***V2 Publishing FM must attend - MK will attend


FM Wednesday May 8th, Q1.

Linda presenting.
Lisa presented a PSS to review the Collaborative CDA Template. Linda is presenting this work.
FHIR coverage is where the work is going to start, most of the resources are still at a low maturity level. For FM, even if the level of maturity is high, the level is 2 since the mapping to the RIM hasn't been done. Once done, it will be raised to FMM 3.
In the beginning, FM put the resources in the RIM, from where they got pulled for CCDA. Most of the resources are attached to the payer, which is OK.
-for coverage,
- there is a sequence number and an indication of priority. Coverage is pretty generic, so when localizing to US, not many fields are going to get dropped.
- what do we use for payer type? (usually used for quality => 4 payer types)
- the coverage type could be overridden for the US.
- the payers have been rolled up in a smaller list for reporting (eCQMs)
- the constraints if mapping to X12 may influence the list.
- 5 main elements:
- the payer <=> organization. Questions about the assignedEntity id. The displayed example looks incomplete. 2.16.840.1.113883.19 is specifically for example purpose. In FHIR, ids are identifying the instance, identifiers are identifying the content.
- the guarantor
- the member <=> beneficiary (!! the relationship goes differently in the 2 models: child<->parent, it describes the relationship from the beneficiary to the subscriber for FHIR/V3 might be reversed in CCDA)
- the subscriber (not present if member is the subscriber) is also the policy holder (but what if the subscriber is an employee and the policy holder is the employer?). In CCDA, it is OK not to have the DoB and address of the subscriber, not for the patient.
- entry relationship (if a prior authorization)
- for prior authorization:
- why is it attached here? There is a resource called Planned Coverage, containing AuthorParticipation and Act. the act is supposed to be the prior authorization. Paul suggests the resource to be renamed as it is more a planned treatment not a planned Coverage, the idea is not to change coverage but authorize a treatment.
- in FHIR, the claim resource is used for the pre determination, the pre authorization and the claim. the claim resource links to the coverage and the procedure. Inside the same facility, it could be done to link a pre authorization to a medical procedure in the implementation of the FHIR server.
The template are to be managed in structured definitions. There is a contract to Lisa Nelson to put the tooling in place for Halloween.

Next topic: DRG:
Question: are you aware of somebody sending a claim where some of the items to link to a DRG and some other to another DRG?
The DRG is not really used in the validation of the claim by the payer.
You expect all items in a claim to be associated to one consistent DRG. It could be, that a patient has a chronic and receives emergency treatment. It would be sent as one claim with a grouper. the primary diagnostic points to the DRG. So it needs to move the body of the claim (today it is in diagnostic as the packageCode, the system might be MSDRGs.). The consensus was DRG should be an extension for R4 and an element for R5.


Salon A

  • Lisa's spreadsheet - Timebox to 30 minutes. 

GOAL: Review the spreadsheet, prioritize and plan for finalization,

  • Tracker items and ballot reconciliation
  • Double check CRD outstanding ballot (already in tracker)

GOAL: Plan recon steps

Data Elements from Lisa Nelson's spreadsheet:
NPI Attending Provider ID
NPI Site Provider ID
NPI Rendering Provider ID
Rendering Provider
Contracting Status Indicator
Claim operating physician NPI
Claim operating physician network status
Claim service location NPI
NPI PCP Provider ID
Allowed Amount
Amount paid by patient
Patient Pay Amount (Pharmacy)
Payment Amount
Non-Covered Reason Code
Non-Covered Amount
Member Zip Code on Claim
Member's Current County
Member's Current Country
Group id
Group name
Patient account number
Medical record number
Claim adjusted from identifier
Claim adjusted to identifier
Claim attending physician network status
Claim referring provider NPI
Claim referring provider network status
Claim performing provider NPI
Claim performing provider network status
Claim other physician NPI
Claim other physician network status
Member reimbursement
Claim primary payer code
Claim primary payer paid amount
Claim secondary payer paid amount
Service to date (Line)

PMQ3Salon A

Determine time for 2nd FM call to discuss DV projects

Da Vinci Prior Auth Support


"final content" FHIR IGs 6/4.
Q4Salon ADa Vinci PDexAttachments


ThursdayMay 9AMQ1

How to capture the work of other projects.

FM next meeting planning

Joint with PAPA


Da Vinci Chronic Illness Risk Assessment, Patient Transparency,

Alerts, Payer Coverage Decision Exchange (SEP 2019 ballot)


Next meeting, work going forward.Attachments

FridayMay 10AMQ1
Not meeting

Not meeting