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Chair:  Robert DieterleViet NguyenAnupam Goel

Scribe: Vanessa Candelora
 

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."

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



Reminder: conference call structure & name changes
  1. Burden Reduction (CRD/DTR/PAS) Implementer Support Call - Wednesday, DTR time slot (11at ET)
  2. Burden Reduction (CRD/DTR/PAS) Supplemental Examples - Friday, PAS time slot (3pm ET)
  3. Burden Reduction (CRD/DTR/PAS) IG Updates/Future Requirements - call to be scheduled, Mondays at 1pm ET


HL7 Sept Connectathon, Sept 9-11 (Virtual)



Connectathon Debrief

2020-09 Connectathon 25

2020-09 Da Vinci CRD / DTR / PAS

Schedules Sessions and Track Highlights Report reviewed by Gary Gryan

Discussion:

  • Bob reminded everyone that CQL is not required, but optional.
  • Viet liked how the days were broken up with educational topics.  More education topics needed was a consensus:
    • CQL is a need
    • Questionnaire session coming up by HL7 (Lloyd teaching) 
    • If you have other topics of interest for educational sessions, reach out to Viet Nguyenor HL7. 
  • Look for information on upcoming event for Da Vinci educational event Oct 27-29, 2020. 
  • Mary Kay: Need additional educational training materials who are not developers but are integral to making stuff runs when the developers have moved on. Need to understand FHIR, read an IG, apply what you are reading. 
    • (LapCorp agrees) People need to understand the IGs to make business rules - need people to know what they are asking on the business side. 
    • very integrated on the payer side 
    • e.g. data element - what is it, do I have it or now in my system? what do I have to make sure my systems have available for this?  
    • Viet Nguyen Vanessa Candelora Setup a call for business analysts support education needed discussion - Mary Kay McDaniel Melanie Combs-Dyer Rachel E. Foerster Alex Thai
      • Outline - start with workflow. Technical Implications vs. Business. Can Mary Kay and Melanie start with an outline to bring to the discussion. 
      • Think about CMS perspective - should this be required? 
    • Viet Nguyen Vanessa Candelora Encourage IG owners to make sure that it's written in a way so that the SHALL statements and data elements are clear to the business analysts/support people to make informed business decisions. 
    • If something breaks, data isn't making it through... how can we arm the BAs to communicate what the problem is. Non-happy path. Error messages for FHIR, HTTP, IG-specific error messages, audit logs - training on this may be useful.  IT support.

Per discussion on the Wed. Call about the message response of "No PA required" but may not have the full picture, could be covered under the Medical Benefit vs. the Rx benefit and message should encourage additional verification with alternative coverage prior to concluding there is no PA required. Mary Kay McDanielRobert Dieterleare working on building out the supplemental example for this response.  There is high interest from third parties about this "block box"

NCPDP - Rep to HL7 is Margaret Weiker Melanie Combs-Dyerwill reach out to her!




Workflow Scenario Examples

Prior Auth Workflow Variation Examples to Further IG Development

Reviewed an updated version of spreadsheet here. 

  • Pain Management - could be DME or under Medical depending. 
  • PT/OT/SLP (Speech Language Pathology)
  • School based claiming - when stuff happens at schools that Medicaid pays for. Kids need IEPs that are based for kids with MS, etc. - Noted and deferred. 
  • Special needs PA requests by the specialist with or without a referral. - Topic to be continued. (Mary Kay and Bob) 








Next agenda

Next week (9/25)'s call is cancelled. We will resume this call on 10/2.

Workflow Scenario Examples


 Adjournment

Adjourned at 4:00pm

Outline Reference

Supporting Document

Minute Approval



Tasks

  •  

Attendees

Present

Name

Affiliation

  •  
Enablecare
  •  
Stratametrics
  •  
Larry DecellesMITRE
  •  
Point of Care Partners
  •  
BCBSAL
  •  

Emily Calvert

CMS
  •  

Erica Ross

CMS
  •  
Heather McComasAMA
  •  
Optum
  •  

Kelly Anderson

BCBSAL
  •  
InterSystems
  •  

Mark Mundt

InterSystems
  •  
Megan SoccorsoCigna
  •  

Mike Funk

Humana
  •  
Nancy SpectorAMA
  •  
AMA
  •  
Tori WillowsWellcare
  •  
BCBSFL
  •  
Aim/ Anthem
  •  

Marci Maisano

Cigna
  •  
Edifecs
  •  
Edifecs
  •  
United Healthcare
  •  
Anthem
  •  
Christy Dodson
  •  
BCBSAL
  •  
Laura Hoffman
  •  
WPS Health Solutions
  •  
Optum
  •  
Edifecs
  •  
CMS
  •  

  •  
CAQH
  •  
Raj
  •  
Ray WilkersonScope Info Tech
  •  
BCBST
  •  
Taha AnjarwallaCAQH
  •  
Tom
  •  
Sonja Ziegler
  •  
Intersystems
  •  
Nandini GangulyEMDI/ Scope Info Tech
  •  
BCBSM
  •  
Kasi
  •  
EMDI Team
  •  
Anthem
  •  
Bart CarlsonAzuba
  •  
Cambia
  •  
Duane WalkerBCBSM
  •  
InterSystems
  •  
Tibco
  •  
Louis BedorCognosante
  •  
Anthem
  •  
CMS
  •  
CMS
  •  
IBC
  •  
Anthem
  •  
Rian
  •  
Palmetto gba
  •  
Sandeep
  •  
Sreekanth PuramMettle Solutions
  •  
Allscripts
  •  
James Gallagher Jr.Premera
  •  
Joseph Figueroa
  •  
Tony LittleOptum
  •  
Pallavi TalekarEMDI/ Scope Info Tech
  •  
Thomas KesslerCMS
  •  
Todd Omundson
  •  
ZeOmega
  •  
Emily TenEyckCAQH
  •  
Mark Taylor
  •  
Julia SkapikCognitive Medicine
  •  
Michael BrodyCME Online
  •  
Michelle ZuttermanHumana
  •  
Surescripts
  •  
Laurie DarstMayo
  •  
Marianna SinghCAQH
  •  
Labcorp
  •  

  •  
Mariana SinghCAQH
  •  
Madhuri
  •  

  •  
Bob THompson
  •  
Ben LangleyMITRE
  •  
Michelle PriestAllscripts
  •  
Michael Hurley
  •  
Cedars-Sinai
  •  
Roland Gamache
  •  
Dave HCRT INC
  •  
Barbara WoodPNC
  •  

  •  
Padma KondaveetiMettles
  •  
Premier
  •  
Cambia
  •  
Judy Williamson
  •  
Matthew Maurer
  •  
Smitha HarishMettles
  •  
BC Idaho
  •  
Michael LunzerAltegra Health
  •  
Rush
  •  
Shilesh NairGdit
  •  
Steve Favilla
  •  
Optum
  •  
Texas Health
  •  
Keya ShahCasnet
  •  
Epic
  •  
Josh Lamb
  •  

  •  
Edifecs
  •  
Max MD
  •  
Allen SaundersChange Healthcare
  •  
Molly Malavey
  •  
Rich BlochLumedic
  •  

  •  
Thomas GrannanAzuba
  •  
Beth ConnorCMS
  •  
MA Health Data
  •  
Kellie Ruff
  •  

  •  
Mark Fleming
  •  
Kumar Elubandi
  •  
Daniel CawoodMCG
  •  
POCP
  •  
Availity
  •  
MITRE/ CodeX
  •  
Sharon Hensley Alford
  •  
Tarun KumarVizlitics
  •  
MITRE
  •  
Tyler HigginsCerner
  •  
Alex ThaiLab Corp

Present

Name

Affiliation

  •  
Rachel GoldsteinCAQH
  •  
Ralph Saint-PhardHealow
  •  
Susan LestinaAHA
  •  
Briana BarnesScope Info Tech
  •  
Cerner
  •  
Cassandra Bell
  •  
Deepthi ReddyMettle Solutions
  •  
Cognosante
  •  
Humana
  •  
Prashanth Golconda
  •  
Rajesh GodavarthiMCG
  •  
Rim Cothren
  •  
Scott LawrenceCMS
  •  
Chris JonesHumana
  •  
Christina BorgLumeris
  •  
Julie MaasEMR Direct
  •  
Kathleen Connor
  •  
Matt ReidAMA
  •  
Mike BerkmanCoverMyMeds
  •  
Monse SerenilHumad
  •  
Rian RaineyCoverMyMeds
  •  
Sandra StuartKP
  •  
Sheryl TurneyAnthem
  •  
Wanda Govan-JenkinsHHS
  •  
Chris HutchinsonCoverMyMeds
  •  
Anna MeisheidCMS
  •  
Cyrus PeyrovianFastAuth
  •  
Janice BakosAetna
  •  
SureScripts
  •  
Gevity
  •  
Melanie JonesCMS
  •  
eClinicalWorks
  •  
Tammy SchreinerWPS Health Solutions
  •  
Amy PetersonHumana
  •  
Dave Trotter, MD
  •  
BCBSIL
  •  
Renee FullerIBX
  •  
Helina Gebremariam
  •  
Cambia
  •  
Intepro
  •  
Carradora
  •  

  •  

  •  
MaxMD
  •  
Cindy Monarch BCBSM
  •  
Dawn PerreaultBCBSM
  •  
Cognizant
  •  
Mitre
  •  

  •  
Missy BoserSurescripts
  •  
CAQH
  •  
Phranil MehtaeClinicalWorks
  •  
Dylan TuggleBCBST
  •  
JPSys
  •  
Mario JarrinChange Healthcare
  •  
Jim AdamsonArkansas Blue Cross
  •  
Brian PoteetBCBST
  •  
Tony LaurieNoridian
  •  
Optum
  •  
Bonnie SirottZeOmega
  •  
MCG
  •  
ESAC
  •  
Edifecs
  •  
Katherine LuskChildrens
  •  
Michael NovalesBCBSIL
  •  
KPMG
  •  
Anupam ThakurBCBS FL
  •  
Cathy PlattnerKP
  •  
Srinivasarao EadaraesMD
  •  
Availity
  •  
ZeOmega
  •  
Dennis ZanettiNantHealth
  •  
Haris BegCambia
  •  
Kishore MetlaMettle Solutions
  •  
Sunitha Godavarthi
  •  

  •  
C-HIT
  •  
SriniesMD
  •  
Anthem
  •  
Kumar SourabhGRSI
  •  
Julia ChanCW Global Consult
  •  
Ric LightHumana
  •  
UHC
  •  
Anil VezendlaMCG
  •  
Ken LordBook Zurman
  •  

Scott Robertson


  •  
Christopher GraconIndependent Health
  •  
Gary GryanMitre
  •  
Mitre
  •  
Marty StaszakVoluware
  •  
Stephen ReckfordGRSI
  •  
Joe HamiltonUnity Point
  •  

  •  
Dave Foster
  •  
Betty SullivanAllscripts
  •  
Cigna
  •  
Juzer KhorakiwallaUHC
  •  
Celine LefebvreAMA
  •  
Eshaa DhalleClinicalWorks
  •  

  •  
Aakash DeliwalaeClinicalWorks
  •  
Chris JohnsonBCBSAL
  •  
Megan RileyMITRE
  •  

  •  
Crystal HyattTransunion
  •  
Epic
  •  
AEGIS
  •  
BCBSM
  •  
Pawan RegmiRush
  •  
Rajesh GarlapatiRush
  •  
Rush
  •  
Scott HoltItiliti Health
  •  
Cigna
  •  
Cigna
  •  
UHC
  •  
Steve KirbyCoverMyMeds
  •  
Neena DakuaWPS Health
  •  
Evicore
  •  
Med Allies
  •  
Laurie Henson
  •  
Healow
  •  
Bapi Beshara
  •  
David DelanoMA Health Data
  •  

  •  
Vishnu
  •  
MITRE
  •  
Daniel C
  •  
Swapnil
  •  

  •  

  •  
Connie SchmidtCerner
  •  

  •  
Mary MartinCancer Linq
  •  
Dave DelanoNEHEN