2020-05-05 Meeting Agenda/Minutes

FM PSS -  Review next week

Accounts, Payments and Statements Project Scope Statement

• Paul presents the project. This would amend the account resource to represent statements. 
• Lorraine notes that the base resource is universal. So this would be a realm specific variance? Paul: The resources will be created or updated in R5 to support US Realm activity. 
• Decision that the project itself isn't really US Realm, so approval isn't necessary at this time.

• FM/PIE (Da Vinci/ CARIN) Subscriber and Dependent issue for all - except Medicare Advantage or Medicare FFS Documentation start for the coverage resource may be: Coverage Identifiers: FHIR R4 Member Identifier, Subscriber ID, Dependent Number

CDPDex Ballot Reconciliation - Payer grants access to applications.  Credentials for apps vs. payer. EOB info available within 24 hrs. 6.Gaps in coverage.  Same contract  Id small business coverage by 2 employers

7. Adult coverage with other adult access. Giving credentials for you access and others you may have access (i.e husband, mother)

Discussed API end point, phone app and access to EOB information for all of this year, or only what has occurred since you last accessed?  What would happen if everyone queried same app every 5 seconds.

Members may or may not have both Portal and App (phone) access.  

Everyone Patient/Member should have a token for each insurance policy (ex: If Donald Duck has Medicare and Commercial insurance the he has a token for each insurance (2 total).  Then access is allowing other patient/member access for same in app by each token.  Can also ask to revoke tokens is you do not need access for another.

Question around 5 year of data based on date 1/1/2016 under requirement. Always have to go back to 1/1/2016 unless not asked for 5 years after you have left the plan. Then plan does not provider this data.

8. Single mom with children discussion. Commercial coverage for Mom and children and also children are covered under Medicaid.

Pat will send out Final Review doc before next week after meeting with Bob. MK- community education needed to understand this process. 

2022 rule - old plan shares 5 data from 1/1/2016 to new insurance plan for patient/member that now has a new insurance.

what happens when commercial member is now on medicare does medicare get the data from 1/1/2016 even if member still has commercial insurance?  Medicare is not part of this process and will not request that data from the commercial.