Inm-fm-claims-attach

Claims Attachment Support'

Problem

• The FM WG would like to talk with InM about how to support a new use case for HL7 v.2 that would allow a provider system to collect the information needed to populate an outbound CDA for claims attachments.
• We think that there may be a gap that could be automated with a query from the Patient Account/Billing System seeking the background clinical information for a claim.
• This might not work for all claim attachment requests, and better for some than others, e.g., where the request is for all clinical information about the patient for the last year vs. the set of lab results from an encounter being billed.
• We think that a query for information in support of a claims attachment would implemented differently depending on the configuration of the provider’s system – e.g., if all the patient records are housed in a clinical data repository, the query would be directly to the repository. *If the system has multiple ancillary systems, the query might need to be broadcast.
• We intend to do more detailed work in San Diego in preparation of proposed changes to Chapter 6 for v.2.8.
• One question we have is whether it’s possible to have a broadcast query where the sender doesn’t know which of a number of systems might have information responsive to the query. Is that even supportable?
• Below are notes from Mary Kay McDaniel’s initial analysis. Attached are some use case/process flow type diagrams – this too is initial and very much at draft stage.
• This is on the InM Agenda for San Diego WGM Tuesday Q2

Proponents

• Kathleen Connor
• Beat Heggli
• Mary Kay McDaniel
• James Dean Whicker

Mary Kay McDaniel's Analysis

Did an analysis of the claim attachment flow on the provider side to determine if any changes are needed.

• How will the information from the attachment generate a response from the clinical data repository?
• Practice management systems are not sending CDA to clinical repositories and repositories are not sending CDA back to Practice Management systems.
• Need a way to send v2.X messages then work into v3 messaging.

• Could be multiple clinical repositories, how to send the request out to multiple systems, or the ‘watcher system’ to gather send to the correct repository/system.
• Can we use just the general notification approach? Managed somehow through the HIS Hub..??

1. Could be a query broadcast
2. Could be a directed query – knows it’s for the lab or ER and hits the appropriate system
3. One clinical repository

• What message version will the response from the clinical repository/HIS/individual system look like.
• how will it be turned from the repository response into the Attachment?