Chair:  Dr.Nita Thingalayaand Dr. Julia Skapik

Scribe: Dana Marcelonis
 

Attendees



Present

Name

Affiliation

  •  
Robert DieterleEnablecare
  •  
Stratametrics
  •  
Nita ThingalayaIBC
  •  
Cambia Health Solutions
  •  
Duane WalkerBCBSM
  •  
Gregory MagazuCaseNet
  •  
Jeanie SmithBCBSFL
  •  
Corey SpearsInfor
  •  
Greg Linden
  •  
Joseph QuinnOptum
  •  
Ashley SteddingCMS
  •  
Barbara AntunaAIM Specialty Health/ Anthem
  •  
Mary Kay McDanielCognosante
  •  
Michael GouldIBC
  •  
Laurie BurckhardtWPS Health Systems
  •  
Serafina Versaggi
  •  
Sreenivas MallipeddiMCG Health
  •  
Susan BellileAvaility
  •  
Susan LangfordBCBST
  •  
Taha AnjarwallaCAQH
  •  
Tony BensonBCBSAL
  •  
Tracey McCutcheonKPMG
  •  
Brent WoodmanBCBSM
  •  
Sonja ZieglerOptum
  •  
Dawn PerreaultBCBSM
  •  
CMS
  •  
Anupam ThakurBCBS FL
  •  
Anthem
  •  
Allscripts
  •  
BCBSM
  •  
Chris JohnsonBCBSAL
  •  
MITRE
  •  
ZeOmega
  •  

  •  
CassieBCBS FL




Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  
CAQH
  •  
Pallavi TalekarScope Info Tech
  •  
Julia SkapikCognitive Medicine
  •  
Kelly TaylorCMS
  •  
Karen L. ZapataAnthem
  •  
Brandon RaabAnthem
  •  
Cindy MonarchBCBSM
  •  
Michael CabralCMS
  •  
Nick RadovUHC
  •  
Anne MeisheidCMS
  •  
Isaac VetterEpic
  •  
James Derrickson
  •  
Laurie WoodromeLabcorp
  •  
Ric LightHumana
  •  
Harvey KuangExpress Scripts
  •  
BCBS AL
  •  
Gevity
  •  
Julia ChanCW Global Consult
  •  
Ken Lord
  •  
Edifecs
  •  

  •  
Roland Gamache
  •  
Alberto S. LlanesAnthem
  •  
Mark ScrimshireNew Wave
  •  
EMR Direct
  •  
Patrick MurtaHumana
  •  
Ranjith KandurAnthem
  •  
Mitre
  •  
Joe Minieri
  •  
Dave Foster
  •  
Providence
  •  
Betty SullivanAllscripts
  •  

  •  
June Bronnert
  •  
Parthiban




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


ManagementBallot and Connectathon Schedule
Julia, Mark and MayVirtual Connectathon Summary

Issue tracking: Implementation Guide Content Workspace

Payer Coverage Decision Exchange Use Cases

  • Data exchange via Reference Implementation, no external testing participants
  • Able to submit CommunicationRequest to FHIR endpoint for Reference Implementation
  • Want to focus on roundtrip exchange in Atlanta
    • CommunicationRequest from new plan to old plan
    • Old plan compiling the coverage transition document
    • Submitting back to requestor/new health plan
    • New health plan receiving information, processing, attaching to a patient record

Julia, Mark and May

What identifiers are used to describe payers for the communication request (CDEX profile)?

  • FHIR endpoints?
  • Plan IDs/TINs?
  • Org names?
  • Websites?
  • Direct Addresses?
  • PCDE uses organization as the requestor, not the paitient
    • CDex CommunicationRequest - can use patient or organization
  • Exchange between payers can occur under HIPAA treatment, operations
  • Plan IDs/TINs?
    • Need a unique identifier for the payer, regardless of plan
    • Endpoint could encompass how the payer identifies - TIN, NAIC ID
    • In some states, parent company could have more than one Issuer ID
    • Given that this is point to point communication - new plan sends request to old plan for information re: a 'shared' member - we already know who is on each end
      • How do you express who is who?
        • When member registers with new plan, the new plan needs to ask where member was previously insured, what was member ID, etc.
      • What's the identifier for the 'old payer', or combination of identifiers to get to the plan level
    • Sender of CommunicationRequest - does their organization include the endpoint that Communication should be sent back to?
    • Prior Authorization Support use case - Julia Skapik to check with Mary Kay McDaniel - we should use same identifier for PCDE - think we're using NAIC ID
  • Will use a LOINC code for document we're requesting in the future - in the meantime, we defined a custom document type code in our own code system
    • Before this guide gets published, we'll have an assigned code - we need a temporary one for Connectathon purposes
    • Chat Comment: who has the action for requesting the LOINC code for this document? Viet NguyenRobert Dieterle to follow up with Dan

  • Response does not need to be Communication - it could just be posting the document to the recipient
    • General pattern is to not use Communication as a wrapper
    • Should we send Communication as a response to CommunicationRequest to summarize action that was taken (i.e., document was posted)
  • PCDE IG currently has CommunicationRequest with Communication in response, to align with CDex (section 2.4.5)
  • Breakout session to discuss a uniform way to handle requests, responses, operations across Da Vinci IGs will be Saturday 9/14 at 4pm in room M104 - https://docs.google.com/spreadsheets/d/1Th0-qhD4u5XTrFt7QeK25xeHxrbC5sF4AU4VTdGxaj0/edit#gid=477899808
    • Need to solidify exchanges, content
  • Need to coordinate with CDex team re: CommunicationRequest and Communication
  • Could use Patient as the Subject, Coverage as the About
  • In the CommunicationRequest, the references could be conditional

ManagementNext agenda

Next 2 weeks will be cancelled due to Connectathon/WGM travel (Sept 13th, Sept 20th)

Next call will be September 27th


 Adjournment

Adjourned at 2:58pm ET


Supporting Documents

Outline Reference

Supporting Document

Minute ApprovalInsert Link to minutes here
Reference to Agenda Item here Payer Coverage Decision Exchange Use Cases

Implementation Guide Content Workspace


Action items