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Present

Name

Affiliation

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Enablecare
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Stratametrics
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Point of Care Partners
  •   
BCBSAL
  •   

Emily Calvert

CMS
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Erica Ross

CMS
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Heather McComasAMA
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Optum
  •   

Kelly Anderson

BCBSAL
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InterSystems
  •   

Mark Mundt

InterSystems
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Megan SoccorsoCigna
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Mike Funk

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

Marci Maisano

Cigna
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Edifecs
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Edifecs
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United Healthcare
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Anthem
  •   
Christy Dodson
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BCBSAL
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Laura Hoffman
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WPS Health Solutions
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Optum
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Edifecs
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CMS
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  •   
CAQH
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Raj
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Ray WilkersonScope Info Tech
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BCBST
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Taha AnjarwallaCAQH
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Tom
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Sonja Ziegler
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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
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Sandeep
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Sreekanth PuramMettle Solutions
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Allscripts
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James Gallagher Jr.Premera
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Joseph Figueroa
  •   
Tony LittleOptum
  •   
Pallavi TalekarEMDI/ Scope Info Tech
  •   
Thomas KesslerCMS
  •   
Todd Omundson
  •   
ZeOmega
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Emily TenEyckCAQH
  •   
Mark Taylor
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Julia SkapikCognitive Medicine
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Michael BrodyCME Online
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Michcelle Michelle ZuttermanHumana
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Surescripts
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Laurie DarstMayo
  •   
Marianna SinghCAQH
  •   
Labcorp
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  •   
Mariana SinghCAQH
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Madhuri
  •   

  •   
Bob THompson
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Ben LangleyMITRE
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Michelle PriestAllscripts
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Michael Hurley
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Cedars-Sinai
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Roland Gamache
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Dave HCRT INC
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Barbara WoodPNC
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  •   
Padma KondaveetiMettles
  •   
Unknown User (meryl_bloomrosen)Premier
  •  
Cambia
  •  
Judy Williamson



Column


Present

Name

Affiliation

  •   
Anthem
  •   
Rachel GoldsteinCAQH
  •   
Ralph Saint-PhardHealow
  •   
Susan LestinaAHA
  •   
Briana BarnesScope Info Tech
  •   
Cerner
  •   
Cassandra Bell
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Deepthi ReddyMettle Solutions
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Cognosante
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Humana
  •   
Prashanth Golconda
  •   
Rajesh GodavarthiMCG
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Rim Cothren
  •   
Scott LawrenceCMS
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Chris JonesHumana
  •   
Christina BorgLumeris
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Julie MaasEMR Direct
  •   
Kathleen Connor
  •   
Matt ReidAMA
  •   
Mike BerkmanCoverMyMeds
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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
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  •   
Christopher GraconIndependent Health
  •   
Gary GryanMitre
  •   
Mitre
  •   
Marty StaszakVoluware
  •   
Stephen ReckfordGRSI
  •   
Joe HamiltonUnity Point
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  •   
Dave Foster
  •   
Betty SullivanAllscripts
  •   
Cigna
  •   
Juzer KhorakiwallaUHC
  •   
Unknown User (patricekuppe)Surescripts
  •   
Express-Scripts
  •   
Celine LefebvreAMA
  •   
Eshaa DhalleClinicalWorks
  •   

  •   
Aakash DeliwalaeClinicalWorks
  •   
Chris JohnsonBCBSAL
  •  
Megan RileyMITRE




Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Milestones
LloydBallot Comment Review

#24166

  • Last week the group agreed that we'd adjust the diagram in the CRD, DTR, PAS IGs to show how they intersect - this comment seems related
  • In order to use DTR, do you need to use CRD?
    • You can use DTR independently
    • DTR involves launching a SMART app to gather a set of information
    • CRD acts as a prompt to launch the SMART app
    • DTR SMART app could be launched at any time, don't necessarily need to wait for the prompt - though it wouldn't be launched in workflow context

#24174

  • Claim acts as a packaging bundle, but items can be processed independently
  • From within EHR system, they'll start accumulating items that they will eventually submit as part of a Claim before the Claim comes together
    • They'll package them up based on timeframe or workflow
  • Payer processing and state management happens at line item level, not overall Claim level 
  • Claim is a logical grouping of line items - from a Prior Authorization or Claim perspective we can operate on individual line items within the overall construct
  • We'll still have the package because there's tracking that's done at the Claim level
  • Processes exist to allow adding items to a Claim after it's been submitted, removing items from a Claim after it's been submitted - this leans towards Claim item being its own resource
  • Internal business processing rules differ from entity to entity
  • If we were to split Claim item as an independently manageable resource, it wouldn't stop anyone from treating the Claim as a cohesive unit, and it would allow for flexibility in processing individual line items independently
  • WEDI Prior Auth sub-workgroup have had similar discussions - Prior Auth request with multiple items in it - there are differences in how payers handle it
    • Wheelchair and accessories example - if accessories are approved but not wheelchair, there's no reason for the accessories. May be a reason to hold until everything is complete
    • Different unrelated services on the same request when you want to move forward on some things without holding everything up
    • Sub-group talked about creating some guidelines around relatedness, but how do you define what's related
  • Resources should enable the range of business processes that exist

#24263

  • CRD uses CDS Hooks, and CDS Hooks only allows JSON
  • PAS mandates XML and JSON
  • General recommendation in FHIR is to support multiple syntaxes when possible
  • What happens if one party in exchange doesn't support the syntax coming to them?
    • PAS mandates that payers have to support both XML and JSON

#24271

  • Providers would be exposing a web hook endpoint, not a FHIR endpoint - a place to post a notification saying there's new data available
    • EHRs have indicated strong interest in supporting this
  • Deferred until Paul Knappis available for discussion

#24292

  • Other tracker items already addressed to add a blurb to clarify how the CRD, DTR, PAS IGs intersect

#24322

  • PAS profiles are not derived from US Core profiles
  • Stayed away from US Core profiles because general X12 guideline to not share information you don't need to
    • X12 278 does carry some clinical information (e.g., diagnosis code) - low industry adoption because it doesn't include specific clinical data payer needs to make medical necessity determination
      • What we're transmitting is 2 sets of information:
        • Claim resource - maps directly into the 278
        • Bits and pieces of Practitioner, Encounter, Patient, Procedure, etc. that expose bits of information that are part of the 278 - focused on what does the 278 require
        • Also allow transmission of full-blown US Core instances of Observation, Encounter, Procedure, MedicationRequest, etc. - those are sent using 275/attachment
        • We're sending same resources twice in the same request with different amounts of information - addressing differences between 278 and 275
      • Data in 275 is put in a binary segment as binary data - not specific data elements - could be PDF, CCDA, any type of document or image
  • Are we comfortable with the PAS profiles standing alone, or do we want to derive from US Core?
    • Originally didn't plan to align PAS profiles with US Core profiles, because we're focused on mapping to 278
    • Concern re: focusing only on 278; US Core is intended to be broader
      • If we inherit elements we don't need, we can't constrain them out
      • If we bring US Core in, we inherit all the 'must supports' for stuff we don't want to be supported
      • EHR vendors are going to implement US Core for the most part
        • We're already adding elements to support 278
    • Group discussion was split between the 2 options
    • Need to continue the discussion next week


Next agenda

Ballot comment review continued


 Adjournment

Adjourned at at 4:04pm 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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