Chair:  @Paul Knapp

Scribe: @MaryKay McDaniel

Call Logistics:  This call is at 11 AM ET, 10 AM CT, 9 MT, 8 AM PT, join using https://join.freeconferencecall.com/fm4

Attendees - list maintained at the bottom of meeting notes.

REMINDER:

Planning to ballot an artifact in the September 2019 cycle? PMO and Project Number BEFORE TSC approval of the PSS by April 7th.

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)

Approve previous Minutes

2019 JAN WGM Meeting Notes, not yet ready for approval




Proposed Agenda,

Ballot Reconciliation, Coverage Requirements Discovery

0) v2.9 FM Reconciliation Spreadsheet needs approval - already late

See changes/updates made in Spreadsheet.

Block Vote

Motion to approve:  Kathleen Connor, Mark Scrimshire 2nd. 13-0-1 (Linda M.)

1) Harmonization Proposals

Thanks to everyone who participated today.   We did have to table two proposals for decisions and completion by FM, which will happen on 
the WG call at 11AM EDT tomorrow.    The plan is to reconvene the Harmonization call with all participants at noon EDT as originally scheduled
tomorrow March 12 to address the final two tabled proposals with any comments or updates from FM tomorrow morning.

If anything changes, I will let everyone on these lists know.

Row 75 (FM Reconciliation spreadsheet see above), Fix table. Motion to approve: Kathleen Connor, Craig Newman. 13-0-1 (Linda M.)

>>>>>

2) email/Questions from Frank/Outstanding Harmonization Proposal, need to review for 12:00 Harmonization meeting Today

From: Frank Oemig <fm@lists.hl7.org>
Sent: Monday, February 25, 2019 3:51 AM
To: fm@lists.hl7.org
Subject: [fm] online verification of Insurance Information using v2.x

hello all,

in Germany we do have the requirement to verify insurance information
via an online service. We are now checking/searching for suitable fields
in v2.x:
Date/Time of online verification:
-> IN3-6 Certification Date/Time
Result of online verification:
-> new field?
error code for online verification:
-> new field, eventually using a specific table in combination with the
previous information?
check-digit of online verification:
-> new field?

https://confluence.hl7.org/download/attachments/30638450/new%20IN3%20fields%20for%20verification.docx?api=v2

Motion to approve with the changes: Laurie Burkhardt, Kathleen Connor: 9-0-0

https://confluence.hl7.org/download/attachments/30638450/v2.9_frank_oemig_fm_1.docx?api=v2

Motion to approve with the changes: Kathleen Connor, Laurie Burkhardt. 13-0-0

https://confluence.hl7.org/download/attachments/30638450/v2.9_frank_oemig_fm_2.docx?api=v2

4 fields to be added. Made changes to the harmonization /table values. Split error codes into error table, left success codes in 1st table. Updates made to the word documents and returned to Harmonization meeting. 

Motion to approve with the changes: Kathleen Connor, Laurie Burkhardt 11-0-0


1.5) FM Interest in C-CDA R2.1 Update PSS

get FM to weigh in on whether they would want to be a co-sponsor or an interested party on the PSS for doing an update to C-CDA R2.1?

Here is the PSS:

https://confluence.hl7.org/display/SD/Consolidated+CDA+STU+2019+Update

We need to Vote on this PSS in SDWG on Thursday. 

Interested party and updated at WGMs - we will define time for the updates...

Kathleen Connor, Laurie Burkhardt. 11-0-0

3) Review New Proposed Da Vinci PSS

      • Alerts (more than just ADT)
      • Attribution (Risk Based Contracts)
      • Chronic Illness Documentation for Risk Adjustment
      • Cost Transparency
      • Payer-Payer Coverage Determination
      • **Co-Sponsored, with Patient Care as Sponsor:  Patient Data Exchange. 

WG reviewed the PSS.

Motion to approve, with the intent that when work begins on the PSS the WG will again review the work in depth.

Mark Scrimshire/Laurie Burkhardt:  8-0-0


4) Vocabulary Facilitator, email from Heather Graham


5) Proposal to enhance balance, statement and payment adjustment data. JAN WGM and HIMSS follow-up.


From the recent discussions at the WGM on proposing enhancements to FHIR to address Balance, Statement, Payment, and Adjustment data that to some started to sound like regular banking transactions rather than transactions specific to “patient/guarantor accounts” that actually already are available through HL7 V2 as well, it seems we landed that we should be able to move forward, but do not necessarily need a separate/new PSS.  In talking with Grahame Grieve at HIMSS he further clarified that while in Australia some of this could be managed through generic banking transactions, in other parts of the globe that would not necessarily be true.  So he would not stand in the way of moving forward, although like anybody, he may provide feedback as specific proposal flow through.  Considering though the questions about project and scope, we’d like to suggest an update to the current FHIR PSS for FM to root the discussions more clearly without surprises down the road.


 Billable Service Invoice, Patient/Guarantor Accounts (including Balance, and Statement data), Claim, Explanation of Benefit, Remittance Advice, Reversals, PaymentReconciliation (including Payment and Adjustment data), Pre-Authorization/Pre-Determination, Coverage, Eligibility,  and other resource corollaries of current HL7 standards supporting these concept such as existing HL7 V3 CMETs and HL7 V2 FT1 segment.

4) Review changes we made for Bill type

5) Insurance type spreadsheet

6) Hospice Indicator.

** Linda will create a tracker. What more does the FM WG need to do?

Paul: Will create the extension in Coverage. Will add into current build. There is no US Core for Coverage (Core was a project).

Tracker 20361, added for R5

Need for indicators for Hospice, LTC, Disability and ESRD.  There is a need to have an indicator when a particular coverage type was invoked. 

There is a monthly file between Medicare (IDR).  Need code to indicate the type of coverage and span for when it applies.

Benoit perhaps had possible business case as well. 

Going to add something to COVERAGE at least a dated data element.  Complex element to be a code and date.  For the US, will need a US CORE code set.  Need code set to ID the types of subplan.  If putting into coverage, will need to be included in any coverage for which it has been invoked.  Will only be for the actual coverage it has been invoked.  It isn’t a status about the person.  It won’t be able to be used for things like pregnancy indicator.  There are other things other than hospice and it must be invoked by the patient (or whatever the process is).   

There are some coverage and other member alerts that limit or impact coverage (high use individual limited to a single pharmacy).  There might be other alerts that would be in a clinical sense, but that wouldn’t necessarily be in coverage.    This new thing is specific to patient invoked rather than limitations imposed on coverage by someone else.   When will change in coverage resource be made so the Da Vinci project, when will it be available for use (R5 in 2 years), but extension can be used in the interim. FM would develop the universal extension.

**) Anesthesia Billing Outreach update - MK

No update.

**) 3/26/2019 - 30 minutes

Payer Section Templates CCDA - Linda Michaelsen

 I would like to request time on your agenda to start talking about the Payer Section Templates.

 http://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?action=edit&ProjectNumber=1437

 Collaborative CDA Template Review Process Pilot

Eventually FM will own/support 3 templates: THIS IS A PILOT. What does it mean for the WG to 'own'?

- C-CDA R2.1 Coverage Activity Entry
- C-CDA R2.1 Planned Coverage
- C-CDA R2.1 Policy Activity Entry

**)Need to discuss Harmonization Process within the WG.


Methodology

Added Items


Ballot Reconciliation



Vo

TrackerIDSummaryOutcome

Moved/

Seconder

VoteComment


















 


Management Next agenda

Tuesday, March 19, 2019 at 11:00 - 12:30 ET


 Adjournment
 Adjourned at 12:30 ET


Supporting Documents

Outline Reference

Supporting Document

Minute ApprovalInsert Link to minutes here
Reference to Agenda Item here Insert Link to document here


Action items


ATTENDEES: 

Present

Name

email

Affiliation

  •  
Kathleen Connor
  •  
Paul Knapppknapp@pknapp.comKnapp Consulting Inc.
  •  
MaryKay McDanielmarykay.mcdaniel@cognosante.comCognosante
  •  
Benoit Schoefflerbenoit.schoeffler@almerys.comAlmerys
  •  
Alex Beckneralex.beckner@cerner.comCerner
  •  
Lou BedorLouis.Bedor@cognosante.comCognosante
  •  
Laurie Burckhardtlaurie.burckhardt@wpsic.comWPS
  •  
Tricia Chitwoodtricia.chitwood@cerner.comCerner
  •  
Rachel FoersterRachel@rfa-edi.com
  •  
Susan LangfordSusan_Langford@bcbst.comBCBST
  •  
Linda Michaelsenlinda.michaelsen@optum.comOptum
  •  
Joe QuinnJoseph.Quinn@optum.comOptum
  •  
Mark Scrimshiremark@ekivemark.comCMS/NewWave
  •  
Najee Shafinajee.shafi@cognosante.comCognosante
  •  
Andy Stechishinandy.stechishin@gmail.com
  •  
Katie Sullivankatie.sullivan@cognosante.comCognosante
  •  
Andy Gregorowiczandrewg@mitre.org

The MITRE Corporation

  •  
Patrick J LaRocqueplarocque@mitre.orgThe MITRE Corporation
  •  
Ray Delanoray.delano@cerner.comCerner
  •  
Larry Decellesldecelles@mitre.comMITRE
  •  
Robert Dieterlerdieterle@enablecare.usEnableCare
  •  
Ben Hamlinhamlin@ncqa.orgNCQA
  •  
Julia Chanjchan@cwglobalconsult.com
  •  
Tom Twaitttwait@cerner.comCerner
  •  
Craig Newmancraig.newman@altarum.orgAltarum

Juana Romanoromemj01.gmail.com
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