HL7 wg project Meeting Minutes Location: Conference Call Date



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HL7 WG Project Meeting Minutes

Location: Conference Call

Date: 06/23/16
Time:
2:00 pm – 3:00 pm Eastern Time

Facilitator:

Craig Gabron

Scribe:

Craig Gabron



Attendee

Name

Affiliation




Craig Gabron

Co-chair




Durwin Day

Co-chair




Jean Narcisi

ADA




Lorraine Doo

CMS




Mcmorrow, Molly M. (US - Arlington)

DoD contract support




Michael Nichols







Patrick Cannady

ADA contract Support




Payne, Ashley

DoD Contract Support




Penny Probst







Susan L Langford







Tom Mort







Brian Flynn







Ciraci, Desirae

Metlife Dental




Nancy Orvis

DoD

















































Quorum Requirements Met: Yes




Agenda Topics

  • Review action items from June 16, 2016 meeting

    1. Reviewed the ADA 1079 Standard for requirements

    2. Reviewed tooth-numbering systems and decided the “JO” World Dental Federation system was out of scope.

    3. Codesets that will apply to the scope – Current Dental Terminology (CDT), Snodent, ICD-10-cm and ICD-10-pcs OIDs exist for these codesets.

    4. Orthodontic requirements will be addressed as an unstructured document and will be codified in phase 2 of the project.

  • Review Periodontal Wiki Page

  • Continue requirements gathering

    • Use cases

  • Discuss Roles



Minutes/Conclusions Reached:


  1. Review action items form 06/16/16

  • The only modification to the action items was the addition of CPT (Common Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) to the list of potential code sets to be used with the periodontal attachment.




  1. Review Periodontal Wiki Page – This is the collaborative workspace for the periodontal team to share ideas and work efforts. In order to edit pages, team members need to establish a logon_id. Another option is to provide your updates to Ashley Payne at aspayne@deloitte.com and she will apply the updates for you.




  • The wiki can be accessed at the following link:

http://wiki.hl7.org/index.php?title=Periodontal_Attachment_Implementation_Guide


  1. Requirements

  • The team discussed the use cases that were identified from last week’s work session to determine whether they were in or out of scope.

    • Claims Adjudication – Unsolicited: There was a lot of great discussion around this topic and the team felt they should be able to provide the periodontal attachment as unsolicited with current trading partner agreements in place. This use case will not require development; it is a business process issue. Since there is no regulation at this time, I reviewed the HL7 definition for unsolicited attachments and it appears to meet the needs of the team. The HL7 definition follows:

Unsolicited Attachment: An unsolicited Attachment refers to the act of providing additional information that conforms to a set of rules-based criteria. These guidelines are defined by the payer through trading partner agreements or published criteria (i.e., policies, websites). The criteria may be for a certain type of claim for a specific health care provider, procedure, or service is known in advance to the provider. This Supplement takes no position with respect to the business reasons that initiate unsolicited attachments.

In the unsolicited scenario, the provider would assign an Attachment Unique ID. This identifier must be provided with the Attachment to be re-associated with the healthcare administrative activity.



    • Claims Adjudication Solicited: This use case factors into the design of the attachment. The attachment must contain all the information needed for codification and business content to satisfy a payers request in order to auto-adjudicate claims. This use case is in scope.

    • Services and Utilization: This use case is also in scope and provides information for internal reviews and post-adjudication review.

    • Provider-to-Provider Exchange: The team agreed to perform additional review for this use case to determine if it will remain in scope for the first phase or be moved to the second phase. One of the issues is the ASC X12 277 for the attachment request is between payer and provider. In the event a regulation specifies that the 277 can be issued from provider to provider or in lieu of regulation, the dental industry agrees to populate and transmit the 277, this use case could remain in scope for phase one.




  1. Roles: Requested dental and payer experts to research the use cases for our next requirements meeting with the following questions in mind:

    1. Provide clear documentation of the current state use case

    2. Document the desired future state use case (once new CDA guide is written and implemented). Provider to provider is a potential future use case.

    3. Define detailed data requirements and trace the use of each data element to the stage in the ADA 1079 where it is used.

    4. For each data element in the ADA 1079 review, whether it is required or optional.

    5. Does the question need to be answered multiple times? (once per tooth) The guide may need one set of data for adults and one set for children.

    6. Is there an explicit list of acceptable answers to be selected from a set of values?




  1. The next meeting is scheduled for June 30, 2016 with a deeper dive into requirements.

Adjournment 2:53




Actions:



Next Meeting / Preliminary Agenda Items

  • June 30, 2016

  • Phone Number: +1 770-657-9270

  • Participant Passcode: 8632591


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