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Chair:  Robert DieterleMay Terry

Scribe: Dana Marcelonis Phung Matthews
 

Attendees

Section


Column


Present

Name

Affiliation

  •   
Robert DieterleEnablecare
  •   
Stratametrics
  •   
Nita ThingalayaIBC
  •   
Cambia Health Solutions
  •   
Gregory MagazuCaseNet
  •   
Jeanie SmithBCBSFL
  •   
Corey SpearsInfor
  •   
Optum
  •   
Ashley SteddingCMS
  •   
Barbara AntunaAIM Specialty Health/ Anthem
  •   
Mary Kay McDanielCognosante
  •   
Michael GouldBCBSA
  •   
Laurie BurckhardtWPS Health Systems
  •   
Serafina Versaggi
  •   
Sreenivas MallipeddiMCG Health
  •   
Susan BellileAvaility
  •   
Susan LangfordBCBST
  •   
BCBSAL
  •   
Tracey McCutcheonKPMG
  •   
Dawn PerreaultBCBSM
  •   
CMS
  •   
Anupam ThakurBCBS FL
  •   
Anthem
  •   
Allscripts
  •   
BCBSM
  •   
Chris JohnsonBCBSAL
  •   
MITRE
  •   
ZeOmega
  •   

  •   

  •   
Cigna
  •   
eClinicalWorks
  •   
Tibco
  •   
Eddy Hernandez-NievesEpic
  •   
Christopher Gracon


  •   
Centene
  •   
Andrea KentCoverMyMeds
  •   
BC Idaho
  •   
Keya ShahCasenet
  •   
Neena Dakua
  •   
Michelle BarryAvaility
  •   
NCPDP
  •   
Shane Mull
  •   
MITRE
  •   
Court
  •   
Ed Sanchez
  •   
Judy Williamson
  •   
Melissa KirchenbauerCGS Admin
  •   
Thomas GrannanAzuba
  •   
UNC Health
  •   

  •   
Guidewell
  •   
John Whittington
  •   

  •   
Jason RhodesPalmetto
  •   
Karen Zajicek
  •   
Kelli Miller
  •   
Michael BrodyCME Online
  •   
Sonya MayOptum
  •   
Michael FasuloRegence
  •   
Bart CarlsonAzuba



Column


Present

Name

Affiliation

  •   
John BialowiczBCBSM
  •   
Nandini GangulyScope Info Tech/ EMDI
  •   
Peter Muir
  •   
Rachel Foerster & Associates
  •   
Pallavi TalekarScope Info Tech
  •   
Kelly TaylorCMS
  •   
Karen L. ZapataAnthem
  •   
Brandon RaabAnthem
  •   
Cindy MonarchBCBSM
  •   
Michael CabralCMS
  •   
Nick RadovUHC
  •   
Epic
  •   
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
  •   
Joseph MinieriMITRE
  •   
Dave Foster
  •   
Providence
  •   
Betty SullivanAllscripts
  •   

  •   
June Bronnert
  •   
Cynthia GinsburgCMS
  •   
Eshaa DhalleClinicalWorks
  •   
Ronald MacDurmon
  •   
Cigna
  •   
Edifecs
  •   
Cigna
  •   
Mona ChandrapaleClinicalWorks
  •   
Sonja ZieglerOptum
  •   
Celine LefebvreAMA 
  •   
 Ben Largley
  •   
Dawn PerraeultBMBSMI 
  •   
Emily TenEyck CAQH
  •   
Joe QuinnOptum 
  •   
Lindee Chin Edifects 
  •   
Lorraine Doo CMS 
  •   
Padame Metal Solutions 
  •   
Rajesh g
  •   
Josh Lamb
  •   
Edifecs
  •   
Sreekanth
  •   
Bapi Bahera
  •   
Charlie Genova
  •   
Gregg JohnsonPalmetto GBA
  •   
MITRE
  •   
Robin FreePalmetto GBA
  •   
Thomas KehoePalmetto GBA
  •   
Toni WheelerCGS Admin
  •   
Mrguen MehtaeClinicalWorks
  •   
David Lowry
  •   
Alex DelagePalmetto GBA
  •   
Roc ViaCGS Admin
  •   
Craig FranklinCGS Admin
  •   
Hal Bowles
  •   
Harry Feliciano, MDPalmetto
  •   
Mrugen Mehta
  •   
AEGIS
  •   
Kevin DayEdifecs
  •   
Zachary Fjeldheim
  •  

  •  
Swapnil
  •  

  •  
Phung Matthews




Minutes Approved as Presented 

...

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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







HL7 FHIR Connectathon - Virtual, Sept 9-11

PCDE Demo UpdatesUpdates May Terry

  • Based on feedback, the following has been updated 
    • PCDE Bundle
      • Claim for operation in medication requirement- is a FHIR resource from Outcomes
      • Medication dispensed is now included
    • Decided to use EOB rather than Claim- the example will be revised to include EOB


PCDE Supplemental Guide

PCDE Supplemental Guide

  • Presently a preliminary rough draft
  • Added sensitive health information
    • Leverage FHIR security label
    • Place snippet example (CarePlan4)
      • Meta security- confidentiality level follows FHIR security IG
      • 2nd set under security as restricted
      • codeable concept inside bundle
      • Condition also has security and should be applied at all resources it is referencing
    • references are represented and resolvable 
    • ensure the use and consistency of marking confidentiality on sensitive information, i.e. the application of confidentiality should be consistent on resources to which it is applied
  • Robert Dieterle will ask CMS if payer to payer becomes protected data or is patient right to cover?
  • consider privacy requirements from state to state- one state may be more or less restrictive than the other state


Flesh out clinical scenario to reflect PCDE payload



ManagementNext agenda
  • Take a moment to look at the supplemental guide
  • Discussion regarding modifiers and representations



 Adjournment

Adjourned at 03:02PM ET


Supporting Documents

Outline Reference

Supporting Document

Minute Approval
PCDE Supplemental Guide

Payer Coverage Decision Exchange Use Cases

...