Chair:  

Scribe: Dana Marcelonis
 

Attendees



Present

Name

Affiliation

  •  
Robert DieterleEnablecare
  •  
Stratametrics
  •  
Nita ThingalayaIBC
  •  
Cambia Health Solutions
  •  
Gregory MagazuCaseNet
  •  
Jeanie SmithBCBSFL
  •  
Corey SpearsInfor
  •  
Optum
  •  
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
  •  
BCBSAL
  •  
Tracey McCutcheonKPMG
  •  
Dawn PerreaultBCBSM
  •  
CMS
  •  
Anupam ThakurBCBS FL
  •  
Anthem
  •  
Allscripts
  •  
BCBSM
  •  
Chris JohnsonBCBSAL
  •  
MITRE
  •  
ZeOmega
  •  

  •  

  •  
Cigna
  •  
eClinicalWorks
  •  
Tibco
  •  
Eddy NievesEpic
  •  
Christopher Gracon


  •  
Centene
  •  
Andrea KentCoverMyMeds
  •  
BC Idaho




Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  
CAQH
  •  
Pallavi TalekarScope Info Tech
  •  
Kelly TaylorCMS
  •  
Karen L. ZapataAnthem
  •  
Brandon RaabAnthem
  •  
Cindy MonarchBCBSM
  •  
Michael CabralCMS
  •  
Nick RadovUHC
  •  
Epic
  •  
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 MinieriMITRE
  •  
Dave Foster
  •  
Providence
  •  
Betty SullivanAllscripts
  •  

  •  
June Bronnert
  •  
Cynthia GinsburgCMS
  •  
Eshaa DhalleClinicalWorks
  •  
Ronald MacDurmon
  •  
Cigna
  •  
Edifecs
  •  
Cigna




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



Connectathon

Connectathon Prep
  • Team working with AEGIS on test scripts
  • Need to work through query to health plan when not a member-authorized exchange
  • 2 different ways of exchanging information for PDex and PCDE:
    1. Member authorized exchange - OAuth 2.0, standard approach, member authorizes new payer app to access old payer data (similar to Apple Health Record, etc.)
      • Requires member to have log on to old payer's portal
      • No question re: who member is
    2. Member enrolls with new payer, and indicates who old payer is
      1. Member knows old payer insurance card information
      2. Member does not have old payer insurance card information
        1. New plan sends member demographic information to old plan (need to at least know plan)
        2. If single hit/patient match
          1. Is there a care plan (PCDE)?
            1. Return empty document - no current care plan
            2. Return relevant documents (asynchronously)
        3. If multiple hits - provide information back to the new plan, and new plan picks the correct member (or they might still not know and can't do the exchange)
        4. Once determine old plan information, new plan would request resources via old plan's API and provide as part of that exchange:
          1. Coverage resource for member in new plan
          2. Coverage resource for member in old plan
  • Open Issues
    • Scope of data returned
      • Is the member authorizing the exchange, or is it covered under HIPAA?
        • If member authorizing, it could be Member Right of Access and Minimum Necessary no longer applies
    • What do we do with sensitive data?
  • Folks are invited to show up for this track at the Connectathon to discuss this approach and provide feedback (don't necessarily need to bring code)
    • Mark Scrimshire and Joe Minieri are PCDE track leads and will be on-site in Philadelphia

ManagementNext agenda

 Adjournment

Adjourned at 2:27pm 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