Facilitator: Chris Johnson Peter Gunter
Scribe: Robin Isgett
|X||Rachel E. Foerster|
Meeting Minutes from Discussion
HL7 ANSI Anti-Trust Policy
HL7 adheres to the ANSI Anti-Trust policy. We should avoid sharing any information on this call that could be interpreted as anti-competitive. If there are topics that you don’t normally speak about in other public settings, such as conferences or trade shows, then it’s probably best to save those topics for another time as this is a public call. If you have any questions you can refer to the GOM section 05.01 or consult your companies legal division.
|Chris Johnson reviewed the Antitrust statement.|
Minutes Approval - Jan 10, 2023
|Minutes approved by consensus.|
New Proposals and PSS for review - PIE comments or interest
Project proposal to enhance the FHIR standard for situations where the individual and their important social relationships are best, and sometimes required, to be expressed using Person-Centric view for FHIR.
After discussion, the PIE WG decided that the project requires better definition, and will ask the submitter for a a clearer definition of what this project is all about before deciding on its role going forward. WG members believed they may be a significant overlap with the Gravity Project with respect to SDOH.
There is an issue around how to submit the subscriber’s name when the patient is not the subscriber. The current version of the IG proposes sending it in the Patient Resource; i.e., there would be two Patient Resources – one for the patient and one for the subscriber. We wish to propose an alternate approach.
|Pat Taylor who provided a summary of the PCT workflow and the bundle concept. Within a bundle there is the Patient Care Transparency (PCT) concept. Ms. Taylor reviewed how the IG covers the use case of when the patient is not the subscriber. Under X12, one would need the subscriber ID and the subscriber name, but not the DOB nor the gender. The IG currently calls for submission of the subscriber information in the patient resource. Therefore, one patient resource would describe the child and the other the subscriber. Mistakes are being made and the proposal is to provide the name of the subscriber in the display. This would allow alignment with claims submission standards in payer adjudication systems. Would change instruction to require subscriber if the patient is not the subscriber. Robert Dieterle suggested that it should require both the subscribe name and ID. In x12 there are two loops, the subscriber and patient. If the subscriber is not the patient then both loops are necessary.|
Ms. Taylor suggested that they will try to streamline instructions to minimize errors and will make recommendation based on the discussions and she appreciated the feedback of the PIE WG.
Advancing Interoperability and Improving Prior Authorization NPRM
Discussion Guide review
Robert Dieterle provided a summary of the proposed CMS rules related to Prior Authorization and Attachments which were a major focus of the HL7 WG meetings. Mr. Dieterle first provided a summary of the Interoperability and Improving Prior Authorization Processes CMS-0057-P regulation including a review of the Covered Plans, Provider Programs, Scope of APIs [Patient Access, Provider Access, Provider Directory, PARDD (Prior Authorization Requirements, Documentation, and Decision) and Payer-to-Payer]. Mr. Dieterle stated that it stipulates the plans that CMS can regulate: Medicare Advantage, Medicaid and CHIP Fee For Service Programs, Medicaid and CHIP Managed Care, and the Qualified Health Plans (QHP) issuers on the Federally-facilitated Exchanges (FFEs). CMS also provides incentives for providers to adopt the regulation.
Mr. Dieterle’s slides are available on PIE website under Documents and Presentations
|Mary Kay||CDex 12X tables for RFAI and Submit Attachments||Rollover to next call.|
|Management||Next agenda||Continue NPRM discussion.|
|Adjournment||Adjourned at 3:30 PM EST|