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Column


Present

Name

Affiliation

  •   
Enablecare
  •   
Stratametrics
  •   
Point of Care Partners
  •   
BCBSAL
  •   

Emily Calvert

CMS
  •   

Erica Ross

CMS
  •   
HeatherAMA
  •   
Optum
  •   

Kelly Anderson

BCBSAL
  •   
InterSystems
  •   

Mark Mundt

InterSystems
  •   
Megan SoccorsoCigna
  •   

Mike Funk

Humana
  •   
Nancy SpectorAMA
  •   
Terry CunninghamAMA
  •   
Tori WillowsWellcare
  •   
BCBSFL
  •   
Aim/ Anthem
  •   

Marci Maisano

Cigna
  •   
Edifecs
  •   
Edifecs
  •   
United Healthcare
  •   
Anthem
  •   
Christy Dodson
  •   
BCBSAL
  •   
Laura Hoffman
  •   
WPS Health Solutions
  •   
Optum
  •   
Edifecs
  •   
CMS
  •   

  •   
CAQH
  •   
Raj
  •   
Ray WilkersonScope Info Tech
  •   
BCBST
  •   
Taha AnjarwallaCAQH
  •   
Tom
  •   
Sonja Ziegler
  •   
Intersystems
  •   
Nandini GangulyEMDI/ Scope Info Tech
  •   
BCBSM
  •   
Kasi
  •   
EMDI Team
  •   
Anthem
  •   
Bart CarlsonAzuba
  •   
Cambia
  •   
Duane WalkerBCBSM
  •   
InterSystems
  •   
Tibco
  •   
Louis BedorCognosante
  •   
Anthem
  •   
CMS
  •   
CMS
  •   
IBC
  •   
Anthem
  •   
Rian
  •   
Palmetto gba
  •   
Sandeep
  •   
Sreekanth PuramMettle Solutions
  •   
Allscripts
  •   
James Gallagher Jr.Premera
  •   
Joseph Figueroa
  •   
Tony LittleOptum
  •   
Pallavi TalekarEMDI/ Scope Info Tech
  •   
Thomas KesslerCMS
  •   
Todd Omundson
  •   
ZeOmega
  •   
Emily TenEyckCAQH
  •   
Mark Taylor
  •   
Julia SkapikCognitive Medicine
  •   
Michael BrodyCME Online
  •   
Michcelle ZuttermanHumana
  •   
Surescripts
  •   
Laurie DarstMayo
  •   
Marianna SinghCAQH
  •   
Labcorp
  •   

  •   
Mariana SinghCAQH
  •   
Madhuri
  •   

  •   
Bob THompson



Column


Present

Name

Affiliation

  •   
Anthem
  •   
Rachel GoldsteinCAQH
  •   
Ralph Saint-PhardHealow
  •   
Susan LestinaAHA
  •   
Briana BarnesScope Info Tech
  •   
Cerner
  •   
Cassandra Bell
  •   
Deepthi ReddyMettle Solutions
  •   
Cognosante
  •   
Humana
  •   
Prashanth Golconda
  •   
Rajesh GodavarthiMCG
  •   
Rim Cothren
  •   
Scott LawrenceCMS
  •   
Chris JonesHumana
  •   
Christina BorgLumeris
  •   
Julie MaasEMR Direct
  •   
Kathleen Connor
  •   
Matt ReidAMA
  •   
Mike BerkmanCoverMyMeds
  •   
Monse SerenilHumad
  •   
Rian RaineyCoverMyMeds
  •   
Sandra StuartKP
  •   
Sheryl TurneyAnthem
  •   
Wanda Govan-JenkinsHHS
  •   
Chris HutchinsonCoverMyMeds
  •   
Anna MeisheidCMS
  •   
Cyrus PeyrovianFastAuth
  •   
Janice BakosAetna
  •   
SureScripts
  •   
Gevity
  •   
Melanie JonesCMS
  •   
eClinicalWorks
  •   
Tammy SchreinerWPS Health Solutions
  •   
Amy PetersonHumana
  •   
Dave Trotter, MD
  •   
BCBSIL
  •   
Renee FullerIBX
  •   
Helina Gebremariam
  •   
Cambia
  •   
Intepro
  •   
Carradora
  •   

  •   

  •   
MaxMD
  •   
Cindy Monarch BCBSM
  •   
Dawn PerreaultBCBSM
  •   
Cognizant
  •   
Mitre
  •   

  •   
Missy BoserSurescripts
  •   
CAQH
  •   
Phranil MehtaeClinicalWorks
  •   
Dylan TuggleBCBST
  •   
JPSys
  •   
Mario JarrinChange Healthcare
  •   
Jim AdamsonArkansas Blue Cross
  •   
Brian PoteetBCBST
  •   
Tony LaurieNoridian
  •   
Optum
  •   
Bonnie SirottZeOmega
  •   
MCG
  •   
ESAC
  •   
Geeta KrishnanEdifecs
  •   
Katherine LuskChildrens
  •   
Michael NovalesBCBSIL
  •   
Tracey McCutcheonKPMG
  •   
Anupam ThakurBCBS FL
  •   
Cathy PlattnerKP
  •   
Srinivasarao EadaraesMD
  •   
Availity
  •   
ZeOmega
  •   
Dennis ZanettiNantHealth
  •   
Haris BegCambia
  •   
Kishore MetlaMettle Solutions
  •   
Sunitha Godavarthi
  •   

  •   
C-HIT
  •   
SriniesMD
  •   
Anthem
  •   
Kumar SourabhGRSI
  •   
Julia ChanCW Global Consult
  •   
Ric LightHumana
  •   
UHC
  •   
Anil VezendlaMCG
  •   
Ken LordBook Zurman
  •   

  •   
Christopher GraconIndependent Health
  •   
Gary GryanMitre
  •   
Mitre
  •   
Marty StaszakVoluware
  •   
Stephen ReckfordGRSI
  •  
Joe HamiltonUnity Point
  •  




Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy



Milestones
  • Mitre is developing Reference Implementation
  • Gevity/ Lloyd McKenzie is lead to author Implementation Guide
  • September ballot cycle schedule
    • NIB - June 30
    • Sign up for ballot opens - July 8
    • Initial content due - July 14
    • QA period - July 21
    • Final Content due - August 4
    • Ballot opens - August 9
    • Ballot closes - September 9
  • Da Vinci Virtual Connectathon - Aug 28 & Sept 4 (2 half days 12-4pm ET)
  • HL7 Atlanta Connectathon - Sept 14-15


Connectathon Track Overview

2019-09 Da Vinci Prior Authorizations (CRD/DTR/PAS)

  • Montreal/Jacksonville Connectathon participants can enter their scenarios into this track
    • MCG is working on congested heart failure scenario (Rajesh Godavarthi) and home health scenario
    • Another example was complex labs/genomics previously tested


  • Mitre question re: multiple items within same FHIR Claim vs. bundle of bundles
    • Claim/$submit operation
      • Prior Auth is a bundle containing Claim and supporting resources
      • Someone can send in a batch of Claims (bundle of bundles)
      • Base submit operation allows more flexibility than is what's required for this IG, and we didn't tighten it as much as we should have
        • Input will always be a bundle, the bundle will always contain a single Claim resource representing the Prior Authorization and supporting data
        • Won't submit multiple, independent Prior Authorizations simultaneously through this IG
    • Trying to keep changes to DTR minimal, coming into Prior Auth
      • What's already there is a bundle with a single Claim and supporting information
      • No item information had been filled in for the Claim
      • When a claim comes in, an ID is generated by the Prior Auth code and that gets attached to the Claim and the bundle - they all have the same ID
        • In future needs to handle updates, different responses will need their own unique iD as well
      • Within Item there's a sequence number - intended to be unique within the Claim, not globally - sequence number would identify the "line" within the Prior Auth
        • Payer may create additional lines that link back to the original 'line number' or sequence number
  • Artifacts tab within the IG has a list of basic examples
    • Home Health Care request has example of updates
  • 2 different modes for updates
    • Updating entire authorization - send everything even if only updating a piece within
    • Updating pieces - need to send a flag as indicator (referenced in the IG)
  • Permission from X12 pending to use example codes for the Connectathon
    • Can we plan some time for participants to discuss X12 questions/topics at Connectathon?
      • Could be a break-out session
      • Could also set up time with Financial Management during workgroup meeting
  • When will entire mapping be available to X12 members?
    • TBD
  • Ballot is currently open for this voting/comments on Prior Auth Support IG


Next agenda

 Adjournment

 Adjourned at at 3:47pm ET


Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Connectathon Kick-Off Presentation and recording
Prior Authorization Support Draft Implementation Guidehttp://build.fhir.org/ig/HL7/davinci-pas/index.html

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