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March 28, 2014 Financial Management Work Group Conference Call

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Conference Call Schedule

  • Occurs on Fridays, beginning February 28, December 19, 2013 @4:00 pm, Eastern Time (New York, GMT-04:00)
  • Phone Number: +1 770-657-9270 Participant Passcode: 686300# (alternative for US if the first number doesn't work: +1 888-321-4501)


Member Name Present
Kathleen Connor Co-chair x
Beat Heggli Co-chair
Paul Knapp Co-chair x
Dmytro Rud x
Mary Kay McDaniel
Jay Zimmerman
Duane DeCouteau
Andy Stechishin x


March 28, 2014 Call Agenda Topics

  1. (5 min) Roll Call, call for agenda item, approve March 14, 2014 Financial Management Work Group Conference Call
# (50 min) FHIR FM Development Work Items:  
  1. (5 min) Other Business and Action Item Review

Presiding Co-chair – Paul Knapp RE: Approval of agenda and minutes

Motion Moved Second Affirm Abstain Opposed

Approval of March 14, 2014 Financial Management Work Group Conference Call






RE Draft FHIR FM Resources: Paul and Andy walked us through the drafts: FM FHIR Claims Resource Spreadsheet

FM FHIR Coverage Resource Spreadsheet Paul and Andy drafted FHIR Claims and Coverage.

Paul took the “kitchen sink” tack because FHIR prefers “all in one” resources that can be profiled. So this would put every discipline required line item detail in one resource for Claims and one for Coverage.

However, there’s the notion of a Billable Item being reused across Patient Account and Billing, Invoices, Claims, Prior Auth, Pre-Determination, Enrollment, Eligibility Verification, Remittance Advice, Coordination of Benefits and Explanation of Benefits.

So we’re not sure which way to go. Would like to have the choice be most efficient for Provider and Payer systems.

An example of the type of questions we’re trying to answer are:

Does it matter if the service line is positioned in a claim or can adjudication systems typically handle references to line items?

Is it possible to create “header” type resources for all financial transaction types: claims, remittance advice, patient accounts, and coverage and re-use a “Billable Item” Resource or do we need multiple “kitchen sinks” for each transaction type?

Seems preferable to create a single Financial Resource to cover the different business use cases since they are all about some type of accounting ledger with a menu of healthcare items (coverage, billable and invoice-able services, and shares of cost/benefits) about which $ changes hands.

We have a limited timeframe in which to get FM FHIR Resources into the next DSTU ballot.

We'll continue with this work next call.

Action Items

  1. Action Item - Kathleen to invite Mary Kay McDaniel to next call for insight into payer system capability for processing FHIR Financial Resources and best approach to structuring.
  2. Action Item - Kathleen to draft minutes and agenda for April 4th call.

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