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Column


Present

Name

Affiliation

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

Emily Calvert

CMS
  •   

Erica Ross

CMS
  •   
Heather McComasAMA
  •   
Optum
  •   

Kelly Anderson

BCBSAL
  •   
InterSystems
  •   

Mark Mundt

InterSystems
  •   
Megan SoccorsoCigna
  •   

Mike Funk

Humana
  •   
Nancy SpectorAMA
  •   
Terrence 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
  •   
Michelle ZuttermanHumana
  •   
Surescripts
  •   
Laurie DarstMayo
  •   
Marianna SinghCAQH
  •   
Labcorp
  •   

  •   
Mariana SinghCAQH
  •   
Madhuri
  •   

  •   
Bob THompson
  •   
Ben LangleyMITRE
  •   
Michelle PriestAllscripts
  •   
Michael Hurley
  •   
Cedars-Sinai
  •   
Roland Gamache
  •   
Dave HCRT INC
  •   
Barbara WoodPNC
  •   

  •   
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
  •   
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
  •   

  •   
Dave Foster
  •   
Betty SullivanAllscripts
  •   
Cigna
  •   
Juzer KhorakiwallaUHC
  •   
Unknown User (patricekuppe)Surescripts
  •   
Express-Scripts
  •   
Celine LefebvreAMA
  •   
Eshaa DhalleClinicalWorks
  •   

  •   
Aakash DeliwalaeClinicalWorks
  •   
Chris JohnsonBCBSAL
  •   
Megan RileyMITRE
  •   

  •  
Crystal HyattTransunion
  •  
Isaac VetterEpic




Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Milestones

Ballot comment review
  • Inviting SAMSHA for next Friday's call, so we'll return to that issue requiring follow up next week

#24114

  • Can you ask for a bundle?
    • Only if you have the ID for it
    • Can search for message bundles and document bundles because they have mandated root resources - can chain through to search in contents of message header or composition
    • No mechanism to search for bundles that contain arbitrary stuff
    • We could define our own search criteria
    • Pure RESTful perspective, we can't assume bundle exists
  • RIght now, we're trying to do a RESTful GET - the way we're doing it isn't giving us what we're looking for
  • Change approach to use new operation endpoint to return 'current' ClaimResponse bundle


  • Process question
    • We proposed disposition in this weekly call
    • Block votes take place in HL7 WG (in this case, Financial Management)
      • Can ask to have an issue removed from the block vote if not comfortable with resolution
    • Change gets applied to IG
    • Put out notice to request withdrawal of negative comments
    • If submitted a negative comment and not happy with the change implemented, can choose not to withdraw it - this could impact whether ballot passes for publication


#24174

  • Need to discuss this item in joint Financial Management/ PPIE workgroup meeting and include Lloyd McKenzie
  • Commenter is saying that we've had to introduce modifier extensions into this IG to deal with fact that we're not conveying the prior authorization request and response cohesively - can respond in bits and pieces - maybe the resource needs to be redesigned
  • You could ask for one or more items to be authorized - answer could authorize all, or possibly add another line item to the list, or partially authorize some but not all the line items that were requested (e.g., approve 2 out of 3) - can be modified from the requestor or responder side - need an information model to support this

#24186

  • Will change wording as proposed

#24269

  • Comment will be withdrawn

#24271

  • Approach to provider systems finding out status of prior authorization request:
    • Poll
    • Subscribe and go retrieve the result
  • Comment withdrawn

#24272

  • Performing provider needs ability to view and/or update the prior authorization, and ordering provider may not know specifically who needs to access and/or modify
  • If provider knows the patient ID, the prior authorization repsonse ID, and they know where to query, then provider will have the right to see the prior authorization - need a more secure model?
  • Defer until providers/payers are on the call to provide feedback


Next agenda

Ballot comment review continued


 Adjournment

Adjourned at at 4pm 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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