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July 17, 2018 Financial Management Work Group Conference Call

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Conference Call Schedule

Freeconference - at online meetings tab select join meeting and enter fm4 Dial in 515 739 1538 Access Code 589967

Attendees

Member Name
Kathleen Connor Co-chair x
Beat Heggli Co-chair .
Paul Knapp Co-chair .
John Moehrke Security Co-Chair
Lorraine Constable .
Andy Stechishin x
Mark Scrimshire x
Grahame Grieve .
Corey Spears .
Mary Kay McDaniel x
Durwin Day .
Lenel James .
Reed Gelzer .
Julia Chan .
Jamie Mosteller .
Alec McLure .
Rachel Foerster x
Eric Ellsworth .
Pete Glibert x
Alex Beckner ,
Susan Langford x
Lou Bedor x
Tricia Chitwood x
Cloud Cray .
Varvara Semenova x
Jim Cain x

Agenda

  • Approval of Agenda
  • V2 Ballot Reconciliation - Pete Gilbert
  • Discuss Use in FHIR of X12 Payor Topology instead of HL7 Coverage vocabulary - Mary Kay
  • Review FM CR & Updates FM FHIR Resources- Paul Knapp

Minutes

  • Kathleen chaired and scribed
  • Pete discussed v2.9 FM ballot comments 195, 202, 203, 223, 224. Since Beat Heggli has retired as FM V2 publisher, Pete offered to update the changes needed to align with earlier changes to PID, OBR, and OBX need [{PRT}] to be fully backward compatible and clarify that ROL is deprecated. He will follow up with commenter to clarify comment 224. Mark moved to approve dispositions, Tricia seconded. 12-0-0.
  • Mary Kay asked for FM July 31st agenda to focus on Zulip discussion where the question was asked if X12 Payer Topology could be used instead of v3 Coverage codes. Mary Kay put several typologies into a spreadsheet for comparison with the v3 Coverage codes. X12 Payer Topology is a pre-coordinated list of US specific public program and private health insurance. NCQA codes are divided among Medicare, Medicaid, and Commercial health plans, which is used for HEDIS reporting. The spreadsheet included examples of insurance lines besides health, and plan types. The goal is to make sure that FM can support the community requirements, and while Coverage has many realm agnostic codes, it would require choosing multiple codes to create post-coordinated Coverage Types. FM may need to consider multiple code systems for post-coordinating e.g., Insurance Line of Business, e.g., home, auto, health, workers comp, with differentiation between commercial/private insurance carriers, government health systems, and public programs such as Military Health, VHA, Medicare, Medicaid, and crime victims compensation, and codes that focus on insurance benefit packages, such as vision, dental, mental health.
  • Paul reviewed proposed dispositions and changes to FM FHIR Resources.
  • The following items have been applied to the current FHIR build for review:
  • 17260 Add Patient to EligibilityRequest and Response: Persuasive
  • 17261 Allow multiple coverages in EligibilityResponse: Persuasive
  • 17296 Add status as a search parameter to Claim/ClaimResponse/EOB: Persuasive with mod - add it to all FM resource search lists - YES already done
  • 17458 Add a 'use' code to EligibilityRequest and Response to identify desired actions: Persuasive
  • 17459 Allow multiple coverages in EligibilityRequest e: Persuasive
  • 17460 Remove BenefitSubCategory from Eligibility resources: Persuasive

These were approved. Mark moved, Tricia seconded. 5-0-0

  • Call ran over but several items deferred to next call:
  • Key Tracker items
  1. Present at admission code for diagnosis (17334) (Claim and EOB (Eligibility?))
  2. Divinci Tracker (17473) (see outstanding tracker for alignment
  3. Coverage (14127) and Zulip re: additional coverage types and dimensions (Discussed above.)
  4. Contract Tracker items
  5. Other Tracker items