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Chair:  Robert DieterleMay Terry

Scribe: Vanessa Candelora
 

Minutes Approved as Presented 



Info

This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



HL7 Da Vinci Education and Implementation Event

October 27-29, 2020

The Da Vinci Education & FHIR Implementation Event will focus on how the Implementation Guides (IGs) address the final rules, including burden reduction and quality measures

Open registration - click here

Wednesday information Session

Thursday connectathon-like session: 

  • PCDE Goal: Test the x12 embedded part of it.
    • Encourage Mettles to test the RI so we can have two completed tests. Sree was looking at this during the last connectathon, it would be great to have them join again to test. 
    • Past Connectathons: Edifex and Guidewell tested in the past and was very helpful and led to the PCDE supplemental guide. 
      • incorporated PA in their test but not as it relates to PCDE.
      • EClinicalWorks, Edifecs (very valuable feedback provided), and GW to participate 
    • Would be great to have IBC join in testing as well.  Nita will follow-up!


IG Status UpdatePCDE Recent block vote completed and updates are made (trouble updating one ticket - Bob is working on this) but all are resolved. 

Discuss building out additional examples for PCDE

  • Examples for sender (how to package) and receiver (for specific problem, what info should they get back?)
  • High Frequency examples, e.g. PA-related - home health? Oncology? COPD? etc. 
  • Final CMS Rule driver for additional examples to express data the same way, aligned with US Core. 
    • Active treatments and Care plans will be shared between old plan and new plan system to system, but for now, people will be involved.  
    • information shared between CRD and DTR is similar to what is shared in PCDE in this scenario. 
  • Package up guidance with examples, Sreekanth and Melanie as an implementers to give input to May and Nita into this process.  
    • pdf data (Cath report, others) - all the same data elements (e.g. procedure code) within the same workflow. So, focus on what's available as structured data (not buried in pdfs, etc.)
    • Payer UM teams will take the data and customize it to what they need for their UI. (current state)

Getting implementer input to further develop examples may be a best approach. 

Discussions to align on definitions like: "Are we on the same page of what a treatment is?" are a good next step to move this IG supplemental guide forward. 

Additional content examples of variations:

  • Add more active treatments or mix/match within in care plans (not just more procedures or diagnosis)
  • PA exists, but no claim yet, in conjunction with PCDE.

Let's continue to hone in on what examples, if any, are needed next week. 



Other





ManagementNext agenda

Discuss building out additional examples, if needed, for PCDE


 Adjournment
Adjourned at 3pm.

Supporting Documents

Outline Reference

Supporting Document

Minute Approval
PCDE Supplemental Guide

Payer Coverage Decision Exchange Use Cases


Action items

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Attendees

Present

Name

Affiliation

  •   
Enablecare
  •   
Stratametrics
  •   
IBC
  •   
Cambia Health Solutions
  •   
CaseNet
  •   
BCBSFL
  •   
Infor
  •   
HealthShare Exchange (HSX)
  •   
CMS
  •   
AIM Specialty Health/ Anthem
  •   
Cognosante
  •   
BCBSA
  •   
WPS Health Systems
  •   

  •   
MCG Health
  •   
Availity
  •   
BCBST
  •   
BCBSAL
  •   
KPMG
  •   
Dawn PerreaultBCBSM
  •   
Mettle
  •   
Anupam ThakurBCBS FL
  •   
Anthem
  •   
Allscripts
  •   
BCBSM
  •   
Chris JohnsonBCBSAL
  •   
MITRE
  •   
ZeOmega
  •   

  •   

  •   
Cigna
  •   
eClinicalWorks
  •   
Tibco
  •   
Epic
  •   
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
  •   
Jia Chen
  •   
Tracy Hautanen-KrielCigna
  •   
Ezequiel Morales



Present

Name

Affiliation

  •   
BCBSM
  •   
Nandini GangulyScope Info Tech/ EMDI
  •   

  •   
Rachel Foerster & Associates
  •   
Pallavi TalekarScope Info Tech
  •   
Kelly TaylorCMS
  •   
Anthem
  •   
Anthem
  •   
Cindy MonarchBCBSM
  •   
CMS
  •   
UHC
  •   
Epic
  •   
James Derrickson
  •   
Labcorp
  •   
Ric LightHumana
  •   
Harvey KuangExpress Scripts
  •   
BCBS AL
  •   
Gevity
  •   
Julia ChanCW Global Consult
  •   
Ken Lord
  •   
Edifecs
  •   

  •   
Roland Gamache
  •   
Anthem
  •   
New Wave
  •   
EMR Direct
  •   
Humana
  •   
Ranjith KandurAnthem
  •   
MITRE
  •   
MITRE
  •   
Dave Foster
  •   
Providence
  •   
Betty SullivanAllscripts
  •   

  •   
June Bronnert
  •   
Cynthia GinsburgCMS
  •   
Eshaa DhalleClinicalWorks
  •   
Ronald MacDurmon
  •   
Cigna
  •   
Edifecs
  •   
Cigna
  •   
eClinicalWorks
  •   
Optum
  •   
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
  •   
Mettles
  •   
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
  •   

  •   

  •   
POCP
  •   
Wesley Kokomoor
  •   
Rakesh MatthewIBX
  •   
Ernestine CooperCumberland CG