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Section


Column


Present

Name

Affiliation

  •   
Robert DieterleEnablecare
  •   
Stratametrics
  •   
Nita ThingalayaIBC
  •   
Cambia Health Solutions
  •   
Duane WalkerBCBSM
  •   
Gregory MagazuCaseNet
  •   
Jeanie SmithBCBSFL
  •   
Corey SpearsInfor
  •   
Greg Linden
  •   
Joseph QuinnOptum
  •   
Ashley SteddingCMS
  •   
Barbara AntunaAIM Specialty Health/ Anthem
  •   
Mary Kay McDanielCognosante
  •   
Michael GouldIBC
  •   
Laurie BurckhardtWPS Health Systems
  •   
Serafina Versaggi
  •   
Sreenivas MallipeddiMCG Health
  •   
Susan BellileAvaility
  •   
Susan LangfordBCBST
  •   
Taha AnjarwallaCAQH
  •   
Tony BensonBCBSAL
  •   
Tracey McCutcheonKPMG
  •   
Brent WoodmanBCBSM
  •   
Sonja ZieglerOptum
  •   
Dawn PerreaultBCBSM
  •   
CMS
  •   
Anupam ThakurBCBS FL
  •   
Anthem
  •   
Allscripts
  •   
BCBSM
  •   
Chris JohnsonBCBSAL
  •   
MITRE
  •   
ZeOmega
  •   

  •  
CassieBCBS FL



Column


Present

Name

Affiliation

  •   
John BialowiczBCBSM
  •   
Nandini GangulyScope Info Tech/ EMDI
  •   
Peter Muir
  •   
CAQH
  •   
Pallavi TalekarScope Info Tech
  •   
Julia SkapikCognitive Medicine
  •   
Kelly TaylorCMS
  •   
Karen L. ZapataAnthem
  •   
Brandon RaabAnthem
  •   
Cindy MonarchBCBSM
  •   
Michael CabralCMS
  •   
Nick RadovUHC
  •   
Anne MeisheidCMS
  •   
Isaac VetterEpic
  •   
James Derrickson
  •   
Laurie WoodromeLabcorp
  •   
Ric LightHumana
  •   
Harvey KuangExpress Scripts
  •   
BCBS AL
  •   
Gevity
  •   
Julia ChanCW Global Consult
  •   
Ken Lord
  •   
Edifecs
  •   

  •   
Roland Gamache
  •   
Alberto S. LlanesAnthem
  •   
Mark ScrimshireNew Wave
  •   
EMR Direct
  •   
Patrick MurtaHumana
  •   
Ranjith KandurAnthem
  •   
Mitre
  •   
Joe Minieri
  •   
Dave Foster
  •   
Providence
  •   
Betty SullivanAllscripts
  •   

  •   
June Bronnert
  •   
Parthiban



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Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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


ManagementBallot and Connectathon Schedule
Julia, Mark and MayLinksVirtual Connectathon Summary

Issue tracking: Implementation Guide Content Workspace

Payer Coverage Decision Exchange Use Cases

  • Data exchange via Reference Implementation, no external testing participants
  • Able to submit CommunicationRequest to FHIR endpoint for Reference Implementation
  • Want to focus on roundtrip exchange in Atlanta
    • CommunicationRequest from new plan to old plan
    • Old plan compiling the coverage transition document
    • Submitting back to requestor/new health plan
    • New health plan receiving information, processing, attaching to a patient record

Julia, Mark and May

What identifiers are used to describe payers for the communication request (CDEX profile)?

  • FHIR endpoints?
  • Plan IDs/TINs?
  • Org names?
  • Websites?
  • Direct Addresses?
  • PCDE uses organization as the requestor, not the paitient
    • CDex CommunicationRequest - can use patient or organization
  • Exchange between payers can occur under HIPAA treatment, operations
  • Plan IDs/TINs?
    • Need a unique identifier for the payer, regardless of plan
    • Endpoint could encompass how the payer identifies - TIN, NAIC ID
    • In some states, parent company could have more than one Issuer ID
    • Given that this is point to point communication - new plan sends request to old plan for information re: a 'shared' member - we already know who is on each end
      • How do you express who is who?
        • When member registers with new plan, the new plan needs to ask where member was previously insured, what was member ID, etc.
      • What's the identifier for the 'old payer', or combination of identifiers to get to the plan level
    • Sender of CommunicationRequest - does their organization include the endpoint that Communication should be sent back to?
    • Prior Authorization Support use case - Julia Skapik to check with Mary Kay McDaniel - we should use same identifier for PCDE - think we're using NAIC ID
  • Will use a LOINC code for document we're requesting in the future - in the meantime, we defined a custom document type code in our own code system
    • Before this guide gets published, we'll have an assigned code - we need a temporary one for Connectathon purposes
    • Chat Comment: who has the action for requesting the LOINC code for this document? Viet NguyenRobert Dieterle to follow up with Dan

  • Response does not need to be Communication - it could just be posting the document to the recipient
    • General pattern is to not use Communication as a wrapper
    • Should we send Communication as a response to CommunicationRequest to summarize action that was taken (i.e., document was posted)
  • PCDE IG currently has CommunicationRequest with Communication in response, to align with CDex (section 2.4.5)
  • Breakout session to discuss a uniform way to handle requests, responses, operations across Da Vinci IGs will be Saturday 9/14 at 4pm in room M104 - https://docs.google.com/spreadsheets/d/1Th0-qhD4u5XTrFt7QeK25xeHxrbC5sF4AU4VTdGxaj0/edit#gid=477899808
    • Need to solidify exchanges, content
  • Need to coordinate with CDex team re: CommunicationRequest and Communication
  • Could use Patient as the Subject, Coverage as the About
  • In the CommunicationRequest, the references could be conditional

ManagementNext agenda

Next 2 weeks will be cancelled due to Connectathon/WGM travel (Sept 13th, Sept 20th)

Next call will be September 27th


 Adjournment

Adjourned at at 2:58pm ET


Supporting Documents

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