Chair: Robert Dieterle , Lloyd McKenzie
Scribe: Vanessa Candelora
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Minutes Approved as Presented
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."
Meeting Minutes from Discussion
|Decision Link(if not child)|
Review ANSI Anti-Trust Policy
|Announcements / Housekeeping|
Planning Da Vinci IG implementation testing?
CMS HL7 Virtual Connectathon - July 2022
Date: July 19-21, 2022
Registration: https://www.surveymonkey.com/r/56MXVRF (Closes June 30)
Need Testers to coordinate in advance and demonstrate interoperability during the event. Opportunity for Implementers to demonstrate capabilities. Sign Up here: Planning Demos Schedule- CMS HL7 Virtual Connectathon - July 2022
|Ballot Reconciliation - CRD|
|Follow-up from past weeks|
Follow-up from past weeks:
Would change a SHOULD to a SHALL :
Appropriate system action change.
|Hans tickets marked for in-person|
Ballot Comments reported by Hans Buitendijk (4 marked for In Person Review)
|Proposed list of CRD tickets ready for this call.|
Proposed list of CRD tickets ready for this call.
https://jira.hl7.org/browse/FHIR-36512 Accuracy section revision
https://jira.hl7.org/browse/FHIR-36509 will CRD Clients be informed of failure to meet the complete documentation requirements?
https://jira.hl7.org/browse/FHIR-36502 delete phrase 'starting a patient visit'
https://jira.hl7.org/browse/FHIR-36477 Add codes
https://jira.hl7.org/browse/FHIR-36474 CPT copyright year
https://jira.hl7.org/browse/FHIR-36471 Suggest adding to overview (note: this overlaps with 36477
If Reporter above is not available, we could discuss the following:
https://jira.hl7.org/browse/FHIR-36189 Da Vinci CRD ignores service-type based delegation by payer
https://jira.hl7.org/browse/FHIR-36187 Where the spec does not specify, it must not mandate
- FHIR-36512Getting issue details... STATUS - Wording seems too broad, request is to make it more discrete, maybe add examples. Proposed something like: there may be limited circumstances that would
Andrea agrees with adding examples, putting a bit more parameters on it.
Not writing policy here. We have the formal Spec and then there is guidance on how to implement.
Suggestion to have a section for this guidance.
How should this be integrated - best practices section (like in CDS Hooks)
Examples like changes in coverage between when the PA is approved and when the patient receives the service.
We want to reduce burden and get patients care. The change in the sentence
1) This IG cannot change behavior about circumstances changing in the real world, payer policy, or policy.
2) the sentence as written is too broad and implies that anything can change, thus minimizing the value of the IG for Prior Auth and it's purpose to reduce burden on patients.
The proposed wording is better. removed the addition about the fax/phone - not needed.
Reviewed and approved.
- FHIR-36509Getting issue details... STATUS - Bob and Lloyd discussed,
If the CRD app is unable to return a response, is it required to launch DTR?
Answer: No. DTR is not required for CRD. The expectation is that CRD is aware of what DTR can and can't do. e.g if you are making a referral, (can't make a decision) then it should know if there is a DTR app for that service to be able to launch it.
Reviewed and approved.
- FHIR-36502Getting issue details... STATUS - Discussed scenarios where it makes sense that CRD would be started at the time of a Patient visit, e.g. Admitting a patient.
Action to create a new encounter would trigger CRD and then CRD would come back and say, by the way, we require Prior Auth.
Pick up here next week.
Side bar question on order sign. Wouldn't we want to do it sooner? You could - at Order select.
Could you recheck for eligibly or re-trigger PR when the service is closer?
Payers have regular Prior Auth policy changes and they would communicate and share.
AMA resource - collected policy changes on Prior Auth during covid: https://www.ama-assn.org/system/files/2021-01/prior-auth-policy-covid-19.pdf
|Ballot Reconciliation - DTR|
Happening on Fridays at 3pm ET.
|Adjournment||Adjourned at 11:57pm ET|
- Robert Dieterle , Varghese Mathew , talk offline about the impact of in network/out of network on whether Prior Auth is required or not (just co-pay impact or more?)
Present Name Affiliation Dawn Duchek Smile CDR
Present Name Affiliation Present Name Affiliation POCP, Da Vinci PMO Sreekanth Puram Mettle Solutions Cognizant MITRE MITRE Change Enable Care MITRE Chetana Suresh IBC Mitre Anna Taylor Smile CDR Christopher Gracon Independent Health Varghese Mathew EPIC Gevity Smitha Harish Mettle Solutions Mallik Nimmagadda MCG RFA, CAQH CORE EverNorth Farheen Khalil eclinicalworks HL7 FM Thomson Kuhn ACP Ricky Zou Cognizant eClinicalWorks Jessica Czulewicz CMS Nicholas Volker AMA Heath EPIC John Donnelly Heather McComas AMA Tibco Joyce Quach MITRE Meg Riley MITRE Optum MaxMD Susan Bellile Availity Sahil Malhotra MITRE Kristina McCann BCBST Beth Connor CMS Christina Dexter Cognizant Michelle Barry Availity Sean O'Quinn Cerner Tim McNeil Surescripts Yolanda Liu MITRE CMS Gary Dickinson Thomas Grannan Rajesh Godavarthi MCG Health Robi Scalfani MITRE Marivie Lanter Jim Denyer IBC United Healthcare Rob Brull Infor Bryan Briegel IBM Watson Health Mettle Katie Russell Covermymeds David DeGandi Cambia Versaggi Consulting David Delano MHDC Amanda Merritt ZeOmega Philip Maher Cerner Don Rucker Trizetto Provider Solutions Mark @Dorrie Speckman Multi-Care ConnectedCare @Kyle Johnsen Epic Deb Conklin Medical Mutual, X12 Chris Johnson BCBSAL @Brian Lind Infor Molly Reese AMA Julie King Cognizant Alyson Broxton Cognizant Vassil Peytchev Epic Amol Vyas Cambia Health Epic Optum Wanda Govan-Jenkins OS/ONC AHA AHA Zach Robin MITRE Yukta Bellani Evernorth Jason Teeple Evernorth Phung Matthews 3M Sheljina Ibrahim Anthem Epic Ryan Bussell Cohere Health Diederik Muylwyk Fred Switzer Epic Christopher Bustard Cohere Health Optum @KD eviCore/ Evernorth Anup Mahansaria Sg3 Tom SmileCDR @Anushe Aly Smile CDR @Tamilka Bevels