2021-09-17 Patient Cost Transparency Meeting

Chair:   , Viet Nguyen Vanessa Candelora

Scribe:  Phung Matthews 

Minutes Approved as Presented 

Agenda Topics

(reminder to record)

Agenda Outline

Agenda Item Meeting Minutes from Discussion Decision Link(if not child)

Management

Review ANSI Anti-Trust Policy

Housekeeping

HL7 Work Group Meetings

Sept 20-24, 2021

35th Annual Plenary & Working Group Meeting (Eastern Time)

Network, learn and influence interoperability!Virtual Event

Learn More and Register here:  https://www.hl7.org/events/working_group_meeting/2021/09/

Call is cancelled for next week. 

Sept 2021 WGM - Da Vinci Discussions   - See here for all the places Da Vinci will be.  

Today Recording 9/17/2021

Project Update Creating FHIR IG Proposal - HL7 milestone is Sept. 24th. 

We are looking for expected implementations, please drop a note in the chat or let Vanessa ( vanessa.candelora@pocp. ) or know if you are interested in being listed. com Viet Nguyen

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."

X12 Comments on the No Surprises Act Interim Final Rule

https://x12.org/news-and-events/news/x12-comments-no-surprises-act-interim-final-rule

Slide deck for today

Chat comments 11:06 AMMe to Everyone

https://confluence.hl7.org/display/DVP/2021-09-17+Patient+Cost+Transparency+Meeting - Notes for today with links to deck.

11:21 AM to EveryoneLinda Michaelsen

how would payer know when it is done?

11:23 AM to EveryoneEric Ellsworth (Consumers' Checkbook)

What if one of the providers provides info that changes another provider's estimate?E.g. anesthesiologist gives the patient a worse ASA score than the surgeon expected

11:25 AM to EveryoneTeddy Rhoads

Are there any thoughts around cooridation of a secondary payer '2 insurance coverages for a member'  or is that out of scope?

11:27 AM to EveryoneSam Undine (BCBSA)

Will the scenarios be presented at a later meeting for feedback after folks have had a chance to digest?

11:31 AM to EveryoneCat Douglas (Florida Blue)

Yes - storage in document repositories for members to access completed AEOBs for a period of time. No to sending back AEOBs to the providers. For GFE, storing the data in the request/response. Both to be future used to audit compliance as well as future state compare the differences between the AEOB and then the post service claim.

11:35 AM to EveryoneViet Nguyen

How does the remit play into the AEOB. The remit is specific and post-service and post-claim, right?

11:38 AM to EveryoneViet Nguyen

Participants - Is question 1 now answered sufficiently? What follow-on questions do we have from Question 1? Please enter here in chat.

11:40 AM to EveryoneEric Ellsworth (Consumers' Checkbook)

Given the likelihood of change leading up to procedures, I'd think an approach that having a static machine-readable "thing" that represents the current state of the AEOB (i.e. more than just a document) in the run-up to the procedure

11:41 AM to EveryoneEric Ellsworth (Consumers' Checkbook)

For a surgery involving anesthesiology, does the cardiologist get access?

11:42 AM to EveryoneCait O'Donnell - Smile CDR

Third party?

11:51 AM to EveryoneViet Nguyen

The providers submitting the AEOBs would need to be able to identify themselves both administratively (NPI/TIN) as well as technically (FHIR)

11:51 AM to EveryoneSam Undine (BCBSA)

Bob, could you share more about that in chat?

11:52 AM to EveryoneBryan Briegel (IBM Watson Health)

the caa provider directory statute requires digital endpoints -

11:52 AM to EveryoneSam Undine (BCBSA)

What's the new element being discussed for Plan Net?

11:52 AM to EveryoneSam Undine (BCBSA)

Bryan, thanks. Do they give more detail on what that entails? Is it email, website, something else?

11:53 AM to EveryoneFrank Opelka

The intent is NOT transaction by transaction reporting back to the billing source. It is to provide a summary of the total cost of care (of all services) so that action can be taken to reduce unwarranted services.

11:53 AM to EveryoneEric Ellsworth (Consumers' Checkbook)

Has there been any workflows developed on the patient's potential actions after receiving an AEOB or GFE?

11:54 AM to EveryoneFrank Opelka

Individuals already know their contracted rates - what they do not know is the number of services provided in an episode of care.

11:54 AM to EveryoneFrank Opelka

Viet, the idea of a pull is excellent.

11:55 AM to EveryoneEric Ellsworth (Consumers' Checkbook)

My guess is that for a good period of time patients are going to have sticker shock

11:55 AM to EveryoneFrank Opelka

The pull should be parse-able to allow for business intelligence at the site of care.

11:55 AM to EveryoneStanley Nachimson

We should be looking to duplicate the current patient EOB process.  

11:55 AM to EveryoneRobert Dieterle (EnableCare)

No new elements -- endpoint is part of the current Plan Net and the FAST national directory work

Next  Share on Inquiry to Payer for the AEOB (which includes the GFE).

Best method for the Payer to Provider AEOB - Push or subscribe, Provider endpoint. 

Management

Next Agenda Cancel for HL7 WGM on 9/24.  Next Meeting is 10/1.

Adjournment

Adjourned at 11:55am ET

Supporting Documents

Outline Reference Supporting Document

Minute Approval

Meeting Presentation Materials CARIN IG For BB Technical Overview 09032021.pdf

Supporting Information Links Patient Cost Transparency Supporting Materials

Da Vinci PCT GlossaryDa Vinci Steering Committee PCT Scope StatementPatient Cost Transparency FAQsPCT Discovery and Requirements - Example ScenariosPCT Project TrackingPCT Requirements Gathering

GFE Data Element List v4.xlsx

Recording Recording 9/17/2021

Action items 

Alice - very important to follow-up with question to CMS: how will the provider do the coordination with other providers in 24hours to get the GFE pulled together?

Type your task here, using "@" to assign to a user and "//" to select a due date

Attendees - 64

Present Name Affiliation

 Viet Nguyen  Stratametrics

 Jocelyn Keegan POCP

 Vanessa Candelora POCP

 Larry Decelles  MITRE

  Gary P. Gryan MITRE

 Joseph Minieri MITRE

 Jeff Brown MITRE

 Tab Harris FL Blue

 Alice O'Carroll FL Blue

 Caitlyn Campi   FL Blue

 Kelly Springmann FL Blue 

  Cat Douglas FL Blue

 Cecilia Funk Optum

 Marci Maisano Cigna

 Megan Soccorso Cigna

 Phung Matthews POCP

 Nita K. Thingalaya IBC

 Heather Kennedy BCBS TN

 Frank Opelka PACES Center

 Richard Bloch Providence St. Joseph

 Ben Teisman  EPIC

 Saul Kravitz MITRE

 Robert Dieterle Enablecare

  Jim StClair Lumedic (Providence St. Joseph)

 Lorraine Doo  CMS

 Luke Rockenbach  Providence St. Joseph

 Mariel Brechner Evernorth

 Kevin Larsen  Optum

 Patricia Taylor BCBSA

 Jacob Woodford  EPIC

 Teresa McSpadden Providence St. Joseph

 Tim McNeil Surescripts

 David DeGandi Cambia

 Shanna Hartman CMS

 Alex Mugge CMS

 Pat Waller Cambia

 Michael Gould BCBSA

 Linda Michaelsen Optum

 Caryn Vaughn Providence Health plan

 India Duncan Optum

 Amanda Garlock  Providence - Imaging

 Seth Wainer Providence Health plan (Compliance)

 Drew Bryan Providence Health Plan (Tech)

 Mary Kay McDaniel Financial Mgmt Group at HL7

 Rany El Diwany  Athena Health

 Tony Benson BCBS AL

 Jill Vincente Weill Cornell Medicine

 Jarrett Cox Weill Cornell Medicine

 Bryan Kirk CCIIO (division of CMS)

 Adam Garner HCA Healthcare

 Brian Johnson HCA Healthcare

 Rebecca Dooley HCA Healthcare

 Scott Abram SutterHealth

 @Lynn Chapple Optum, x12 Co-Chair for 837 IGs

 Ali Ozden

 Alvin Yu Optum

 Amy Kelly Medical Mutual

 Anthony Omosule 

 Ashley DePalma MVP Healthcare

 Barbara Doyle BAH

 Behara, Prasanthkumar

 Beth Davis AllScripts

 Brian Dwyer POCP

 Bror Johnson retentionsearch 

 Cambridge, Joseph

 Choudhury, Shafaq

 Durwin Day BCBSIL 

 Eric Grindstaff AllScripts

 Erin Weber CAQH

 Hayer, Andy

 Heather McComas  AMA

 James Macurak

 Janice Karin MHDC

 Jo Thompson Molina

 Joe Quinn HSX

 Jonathan Perry CMS

 Keeli Kellene Strub

 Kris Encino WebTPA

 Mark Pencek Medical Mutual

 Matt Schuller BCBSA

 Melanie Combs-Dyer  Mettle Solutions

 Michelle Barry Availity

 Mike Denison Change Healthcare

  Michael Marchant UC Davis

 Nikki Henck Ideal Care Solutions

 Phranil Mehta  Healow

  Rachel E. Foerster Rachel Foerster & Associates, Ltd.

(RFA)

 Shelly Kitchen

 Sheryl Turney Anthem

 Stanley Nachimson  Nachimson Advisors LLC

 Stephanie Raymond Tufts

 Susan Gartzke

 Susan Langford BCBS TN

 Terrence Cunningham AHA

 Thomson Kuhn

 Cait O'Donnell Smile CDR

 Bryan Briegel IBM Watson Health

 Shawn Bryant WPS

 Collin KreKlow WPS

 Denise St Clair Acumen

 Genie Cilliam Anthem

 Jim Haley Arkansas  Blue

 Peter Liu Smile CDR

 Mark Scrimshire OnyxHealth.io

 Khalid Muqueeth Inovalon

 Katie Leblanc PSJ

 Jean Mitchell WPS

 Nick Merrick

 Sam Undine BCBSA

 Tara Rose

 Tom Mort Availity

 Kim Turner WPS

 Anil N

 Bettina Vanover Cognizant

 Danny iacovou

 Samuel Benton

 Serafina Versaggi

 Diederik Muylwyk Smile CDR

 Pooja POCP

 Thomas Mort

 Yolanda Liu MITRE

 Jessica Czulewicz CMS

 Kamashi Cognizant

 Kirk Fahlberg

 Debbie Stimmel

 Aria Walker

 Jon Woolf

 Taha Anjarwalla

 Christopher Gracon X12

 Kimberly Bradbury

 Caleb Wan MITRE

 Nick Dahl Cognisant

 Rennil Cruz

 Eric Ellsworth

 Suzanne Houlton

 Kaitlin Powers CAQH

 RAnjith Kandur Anthem

 Jeff Helman

 Hong Huang Cambia Health

 Amol Vyas Cambia Health

 Corey Spears MITRE

 Nick Radov

 Paul Knapp

 Vik Sachdev

 Seth Paradis

 Casey Smith Providence

 Bob Bowman

Attendees from today 9/17:

Amol Vyas (Cambia Health)

Aria Walker

Aria Walker

Barbara Doyle

Bettina Vanover

Bryan Briegel (IBM Watson Health)

Cait O'Donnell - Smile CDR

Caitlyn Campi

Caleb Wan (MITRE)

Caryn Vaughn

Casey Smith (Providence)

Cat Douglas (Florida Blue)

Celine Lefebvre

Clark, Marjorie

Collin Kreklow (WPS)

Corey Spears (MITRE)

Denise St Clair (Acumen)(she/her)

Drew Bryan (Providence)

Durwin Day

Erin Weber

Eric Ellsworth (Consumers' Checkbook)

Frank Opelka

Funk, Cecilia

Gary Gryan

Genie Gilliam (Anthem)

Hong Huang

Jacob Woodford (Epic)

Jean Mitchell (WPS)

Jeff Brown (MITRE) - HL7 FM Co-Chair

Jessica Czulewicz (CMS)

Joe Minieri

Julie Burgoon

Kaitlin Powers (CAQH CORE)

Kenny Wang

Kevin Larsen, MD Optum

Khalid Muqueeth (Inovalon)

Kimberly Bradbury

Larry Decelles (MITRE)

Laurie Warren

Leon Jang (Ability Network)

Linda Michaelsen

lorraine doo

Lynn Chapple

Mariel Brechner

Mark S( )onyxhealth.io

MaryKay McDaniel (Markam - HL7 FM CoChair)

Melanie Combs-Dyer (Mettle)

Michelle Barry

Nick Merrick

Nikki Henck, Smile CDR

Rachel Foerster

Ranjith Kandur (Anthem)

Rany El Diwany (athenaHealth)

Rennil Cruz

Robert Dieterle (EnableCare)

Rockenbach, Luke (Providence)

Sam Undine (BCBSA)

Scott Abram

Serafina Versaggi

Stanley Nachimson

Susan Langford

Taha Anjarwalla

Teddy Rhoads

Teresa - Providence

Tony Benson

User

Vanessa Candelora

Viet Nguyen

Vik Sachdev

Walsh, LaToya

Yolanda Liu