Kelly Butler Emdeon Jan/Feb Jamie Mosteller Siemens Healthcare

Transcription

1 ASC X12N TG2 WG2-20 Group Minutes X12N TG2 WG02 Health Care Claims June 3-6, Indianapolis, IN Group Leadership Chair Name Company Term End Phone Date Kelly Butler Emdeon Jan/Feb Jamie Mosteller Siemens Healthcare October s.com Tom Drinkard Delta Dental VA Jan/Feb lva.com Gloria Davis QSI/NextGen Healthcare Information System October Secretary Name Company Term End Phone Date Katie Sullivan Cognosante, LLC Quorum Requirement Statement This group enforces quorum requirements for group voting items. This group does not enforce quorum requirements for group voting items. X Work Products and Status (e.g. Transaction Sets Implementation Guides, etc.) Work Product Name Work Product Status Work Product ID # (opt) Health Care Claim: Professional Voted to Publish Health Care Claim: Institutional Voted to Publish Health Care Claim: Dental Voted to Publish Health Care Claim: Data Reporting Voted to Publish Health Care Predetermination of Benefits Published (Professional) Health Care Predetermination of Benefits (Institutional) Published Scheduled Meetings Type of Meeting Date Location/Call in Contact Agenda Current Meeting 6/3/ Indianapolis, IN Co-Chairs DMs To DSMOs Change Requests/BRTS 6/6/ Next Standing N/A N/A N/A Disbanded Meeting Interim Meeting N/A N/A N/A Disbanded Revised 3/2011 Page 1 of4

2 Voting Items Type Issue Description MISC Responses are needed for CAQH/CORE Operating Rules Survey Motion To approve the workgroup s responses to the CAQH/CORE survey questions. ASC X12N TG2 WG2-20 Vote Motion Made by 2 nd By Approve Disapprove Abstain Gigi Medenhall Harold Smith Discussion None Voting Items Type Issue Description CR 88 ICD-9 and ICD-10 on the same claim Motion To close CR and remain silent surrounding use of ICD9/ICD10 on same claim Vote Motion Made by 2 nd By Approve Disapprove Abstain Doug Renshaw Laurie Woodrome Discussion None Voting Items Type Issue Description CRs Open CR Issues Motion To approve changes for the CRs as documented in spreadsheet. Vote Motion Made by 2 nd By Approve Disapprove Abstain Doug Renshaw Gigi Mendenhall Discussion None Voting Items Type Issue Description CR #345 Need a new loop to support reporting of information for outside labs previously reflected in the rendering provider loop. Motion To create a new loop (yet to be determined) to house the business needs for independent laboratories, portable Xrays, etc. Vote Motion Made by 2 nd By Approve Disapprove Abstain Laurie Burckhardt Nancy Spector Discussion NUCC/X12 defined rendering provider as an individual, but this created issues for labs Having the rendering provider including labs created other issues specifically causing confusion surrounding reporting of the service facility vs. rendering Some organizations have registered their labs as individuals and changes may be problematic, but likely can be addressed through mapping of data Technical solution should include : NM1, N3, N4 and possibly the PRV and REF ACTION: Laurie Woodrome and Laurie Burckhardt will work on Business Requirements and Technical Solution (BRTS) document Voting Items Type Revised 3/2011 Issue Description Page 2 of4

3 BRTS ASC X12N TG2 WG2-20 Need a Business Requirements and Technical Solution document. CR 1214 It is not always known when a claim may be printed and mailed, so the situational rule for the reporting of Payer Address and Other Payer Address needs to allow for its submission at the sender Motion To approve the Business Requirements and Technical Solution document for CR#1214 Vote Motion Made by 2 nd By Approve Disapprove Abstain Harold Smith Rachelle Caldwell Discussion None Voting Items Type Issue Description CRs Open CRs Issues Motion To approve changes for the CRs as documented in spreadsheet. Vote Motion Made by 2 nd By Approve Disapprove Abstain Annette Atherton Doug Rensahw Discussion None Voting Items Type Issue Description BRTS Need a Business Requirements and Technical Solution document. CR 738 CR 1216 Motion To approve and move the Business Requirements and Technical Solution documents to TGC for CR#738 and CR#1216 Vote Motion Made by 2 nd By Approve Disapprove Abstain Betsy Clore Annette Atherton Discussion Voting Items Type Issue Description BRTS Need a Business Requirements and Technical Solution document. CR 1030 Motion To approve and move CR# 1030 Business Requirements and Technical Solution document to TGC. Vote Motion Made by 2 nd By Approve Disapprove Abstain Doug Renshaw Betsy Clore Discussion None Key Discussion Item Discussion CAQH/CORE Survey Revised 3/2011 Page 3 of4

4 Reviewed the CAQH/CORE Determined applicability of previous rules to the 837 claims Prioritized potential additional rules Decisions See Survey Documentation See voting items Discussion Change Request Reviewed open change requests Decisions See voting items See CR spreadsheet ASC X12N TG2 WG2-20 Revised 3/2011 Page 4 of4

5 June 5, Aileen Belen Kaiser Permanente Aimee Y. Thatcher Magellan Behavioral Health Alison Schambach Edifecs Inc. Allen McDonald Amrita Kalkura Amy Blackburn Amy Costello Andrea Lynch Andrew Chung Andy Cress Angie Bartlett Anne-Marie C. Hooper Anthony Kane Anthony Rizzi Arlene Hoelscher IAIABC / Texas Department of Insurance Edifecs Inc. ZirMed, Inc. National Assoc of Health Data Organizations (NAHDO) Kaiser Permanente XIFIN, Inc. Blue Cross and Blue Shield of South Carolina CMS/HHS HCA Healthcare QSI/NextGen Healthcare Information System Kaiser Permanente PNC Bank B. Annette Atherton ZirMed, Inc. X X X Balaji Natarajan Barb R. Keiley Mercury Data Exchange, Inc. Premera Blue Cross Beth Ortega HP X X X X Betsy B. Clore Wake Forest University Health Sciences X X X X Betty M. Lengyel-Gomez Bill Day Bill Gobtop Billy G. Haddox Bobbett Plummer ZirMed, Inc. Illinois Medicaid (Department Of Public Aid) State Farm Insurance Companies VIPS, Inc. CMS/HHS

6 June 5, Brain Flynn National Association of Dental Plans X X X Brenna Hutton Brian G. Dodge Brian Pabst Brian S. Reitz Brigid Noonan Seattle Children's Hosptial Health Management Systems CMS/OFM CMS/HHS Gateway EDI, Inc. Cameron Gunderson Utah Health Information Network X X X Carol A. Tussinger Carol Benchouia Carol Lewis Carol Thompson Carolyn E. Anderson Blue Cross and Blue Shield of Florida Valence Health, Inc. HP United Health Group Mayo Foundation Catherine M. Luett Humana Inc. X X X X Cathi Anderson Cathy Brock Cathy Carter Cathy Plattner Blue Cross Blue Shield of Michigan Blue Cross Blue Shield of Minnesota CMS Kaiser Permanente Chanelle Jones CMS X X X Cheryl A. Atkinson Cheryl Douthitt Cheryl Kelly Cheryl Parkins Humana Inc. UnitedHealth Group State of Arizona - AHCCCS Clinitech Information Resources Cheryl Tichonevicz Highmark, Inc. X X X Chris H. Augustine Christine Doyle, M.D. Highmark, Inc. American Society of Anesthesiologists

7 June 5, Christol Green Wellpoint, Inc. X X X Christopher Hahn Christopher J Gracon Christy Walt Cindy Ellis Claire Salac Claudette Sikora Clint Walker Curtis Milberger Cynthia A. Anaya VIPS, Inc. Independent Health Central WA Hospital HP Independent Health CMS/HHS ExtraDent California Medicaid Depart of VA-Health Administration Center Cynthia Fiore United Health Group X X X X Cynthia Gleason Dan Tankersley Daniel Fisher Daniel Saunders Danielle Stickel Darlene Gandara Dave A. Rohman Dave Spring Dave Yoder David A. Feinberg Illinois Medicaid (Department Of Public Aid) Clinix Medical Information Services, LLC Blue Cross and Blue Shield of Alabama Cognosante, LLC Metropolitan Life Insurance Company Kaiser Permanente State Farm Insurance Companies Illinois Medicaid (Department Of Public Aid) Humana Inc. Rensis Corp. David Coomer Humana Inc. X X X X David J. Bennett State Farm Insurance Companies Dean Cook National Government Services X X Debbi Meisner Emdeon, LLC

8 June 5, Debbie Mefford TrailBlazer Health Enterprises, LLC Debbie Taylor Humana Inc. X X X Deborah Jackson-Johnson Health Care Service Corporation (HCSC) X X X X Debra Strickland Denise Knowles Desireee Van Lieu Eemergence/TIBCO System Designs, Inc. Pinnacle Business Solutions, Inc Don Fleishman Delance Corporation X X Donald D. Holmes Delta Dental of California X X X X Doreen Espinoza Utah Health Information Network Doreen Lance Florida Blue X X X X Douglas Kyle Tampa General Hospital Douglas Renshaw Highmark, Inc. X X X X Duane Walker Blue Cross Blue Shield of Michigan Elizabeth A. Buckley HP X X X Elizabeth Templeton First Coast Service Options, Inc. Eric Kirnbauer Tesia Clearinghouse, LLC X X X Fred Rooke Gail S. Kocher Gale Scott CMS/HHS Blue Cross and Blue Shield Association Tampa General Hospital Ganesh Ramu MZI Health Care X Gary Moon Gayle Dooley Professional HealthCare Support Services Corporation (PHSSC) Aetna Inc. Gema Medina Health Care Service Corporation (HCSC) X X X X Gene Bence Genevieve Davis Post-n-Track American Medical Association

9 June 5, Geoff Palka Epic Systems Corporation George Arges Americal Hospital Association Gigi Mendenhall HP X X X X Gil Shifren Ginger Fraley Humana Inc. Central WA Hospital Gloria Davis QSI/NextGen Healthcare Information System X X X X Greg R. Gehman MEDecision, Inc. Harold Smith North Carolina Division of Medical Assistance X X X X Harriet Settle Harvey Mintz Heath Vaughn Hetty Khan Jack A. Joseph Jacquelyn Pryor James Lunceford Laboratory Corporation Of America CSC Blue Cross Blue Shield of Alabama CDC - NCHS U.S. Department of Veterans Affairs Magellan Behavioral Health AAHAM James Mosteller SIEMENS Medical Solutions X X X X James Nielsen Jana White Jane Depeaux Utah Health Information Network TrailBlazer Health Enterprises, LLC Horizon Blue Cross Blue Shield Of N.J. Jane White Capital Blue Cross X Jean Lama Jean Narcisi Independent Health American Dental Association Jeff Gustafson Gateway EDI, Inc. X X X Jeff Rohlman Jerry L. Brown ExtraDent Health Management Systems

10 June 5, Jill Money Blue Cross Blue Shield of Mi X X X Jim Whicker Jim Whicker Workgroup for Electronic Data Interchange (WEDI) Kaiser Permanente/AAHAM Jimmy Terrapin Blue Cross Blue Shield of South Carolina X X X Jo Brooks Joanne Hoagland JoAnne M. Weingarth TrailBlazer Health Enterprises, LLC Horizon Blue Cross Blue Shield Of N.J. Wellpoint, Inc. Jodie Banks RelayHealth X X X Joey R. Lawhorn Hubbert Systems Consulting, Inc John Bock Independent Member X X John Evans John Furey John Randzo John Rowell Joyce Cianciola Judi Plesetz Judith Pasick Julia Dunicheva Julie Jensen Julie Payne RelayHealth Mitchell SIEMENS Medical Solutions Wellfare Pension & Administration Services (WPAS, Inc) Wellpoint, Inc. Humana Inc. Metlife Edifecs Inc. Cerner Corporation Health Technologies Kam Lee-Jara HP X X X Karen Encinosa Kate Copes Tampa General Hospital State Farm Insurance Companies Katherine Sullivan Cognosante, LLC X X X X Kathleen P. Ochal SIEMENS Medical Solutions

11 June 5, Kathy Cool CIGNA/Sagamore Health Netowrk X Kelly Butler Emdeon, LLC X X X Kelly Schork Kenneth K. Erdmann Kim Henricks Kim Lieffring Gateway EDI, Inc. Delta Dental of Michigan, Ohio & Indiana Mayo Foundation Humana Inc. Kirk Boaz State Farm Insurance Companies X X Kristin Delfino Kristine Weinberger State of Alaska, Department of Health and Social Services Edifecs Inc. Laura Caldwell CSC X X X X Laurie A. Darst Mayo Foundation Laurie Burckhardt WPS Insurance Corp. X Laurie Woodrome Laboratory Corporation Of America X X X X Linda A. McCardel Linda Sue Johnson Linda Vatter Michigan Public Health Institute IBM Corporation ZirMed, Inc. Linda Williamson Aetna Inc. X X Lisa Munn Cerner Corporation X X X Lisa Savicki Humana Inc. X X X Lisa Sloan Lori McLaughlin Luella Guevara Lynn Walker Mandy Aleaga HCA Healthcare Wellpoint, Inc. Kaiser Permanente Kaiser Permanente Mitchell International Marc Leib, M.D., J.D. American Society of Anesthesiologists X X X

12 June 5, Mark Carter State Farm Insurance Companies X X X Mark Harris Mark Williams Gateway EDI, Inc. State Farm Insurance Companies Martin C. Wilbanks U.S. Department of Veterans Affairs X X X X Martin Jensen Mary Anne Zingaro Mary J. Lynam Mary Kay McDaniel Mary L. Tyra Mary Winter CNI Administrative Services, LLC (MSPRC) Blue Cross and Blue Shield of Florida Argus Health Systems Mary Kay McDaniel, I.M. Depart of VA-Health Administration Center PrimeWest Health System Matthew A. Klischer CMS/HHS X X X X Meledie Meyer Michael Cabral Michael K. Pettit Michelle Bianchi Michelle Mauro Mike Parrish Missy Jamison Nancy J. Nemes Nancy L. Sloan Nancy McGuire Nancy Reed Nancy Sanchez-Caro Nancy Senato WPS Insurance Corp. CMS/HHS New York State Department Of Health TrailBlazer Health Enterprises, LLC Washington Publishing Company Delta Dental of Virginia National Center for Health Statistics (CDC) NCPDP/CatalystRx Wellpoint, Inc. TrailBlazer Health Enterprises, LLC Health Care Service Corporation (HCSC) Montefiore Medical Center, Professional Services Aetna Inc. Nancy W. Spector American Medical Association X X X

13 June 5, Nirmalkumar Ekambaram Mercury Data Exchange, Inc. Ornela Basho American Dental Association Pam Cottrell Premera Blue Cross Pamela A. Grosze PNC Bank Pamela M. Davis System Designs, Inc. Pat Edmondson Humana Inc. Pat Van Dyke ODS Patrick Cannady American Dental Association Patrick DeBorde Pricewaterhouse Coopers Patrick McLaurin Mitchell International X X X Penny Dubuc Pete Cutler Peter E. Rausch Peter L. Anderson Peter Strand Peter Walker BJC Healthcare Washington State Office of Insurance Commissioner DeCare Dental, LLC UnitedHealth Group Valence Health, Inc. Aetna Inc. Phil Martinez Mitchell International X Philip L. Evelsizer State Farm Insurance Companies X X X X Pramod Kumar Epic Systems Corporation Rachelle Caldwell Illinois Medicaid (Department Of Public Aid) X X X X Randy James Raymond Sevier Rebecca Morgan Regina Davis Regina Gibson Professional HealthCare Support Services Corporation (PHSSC) State Farm Insurance Companies Mitchell WCS PNC Bank Blue Cross Blue Shield of Michigan

14 June 5, Rini Jose MZI Health Care X Robert A. Davis Robert Davis, I.M. X Robert A. Davis National Assoc of Health Data Organizations (NAHDO) X Robert Barbour Robert Brandenburg Robert Corea Ron Birkemeyer Ron Dashwood Ron Story Ron Territ American Medical Association American Imaging Management Mitchell International Blue Cross and Blue Shield of Minnesota XIFIN, Inc. Delta Dental of Michigan, Ohio & Indiana DataBay Resources Rose Hodges Aetna Inc. X X X Sally Klein Sam Rubenstein Sandy Eldridge Sarah Lyons Sarah Shirey-Losso Scott Danson Shailen Dabhi Shari Walker Sharlene Ramey Sharon Owens Shelly Spiro FOX Systems, Inc. Montefiore Pinnacle Business Solutions, Inc Accenture CMS/HHS Blue Cross Blue Shield of Alabama Illinois Medicaid (Department Of Public Aid) ExtraDent Kern Health Systems U.S. Department of Veterans Affairs Pharmacist Services Technical Advisory Coalition (PSTAC) Sherry Lawler Wellpoint, Inc. X X X X Sherry Wilson Stacey Barber Jopari Solutions, Inc. HPES

15 June 5, Stacey Bickford Zoll X X X Stefan Fromm Central WA Hospital Steve Cloutier Blue Cross Blue Shield of Michigan X X X Steve Sekely Stewart M. Presser Sue Thompson Susan Leonardi Susan Watson Tab Harris DataBay Resources Greater New York Hospital Association Nat'l Council for Prescription Drug Prog. Mitchell International Allstate Insurance Company Blue Cross and Blue Shield of Florida Tammara JeanPaul National Center for Health Statistics (CDC) X X X Tammy Banks Tammy Patchett Tara Delone Teresa M. O'Connor Terri Robben Theresa Behling American Medical Association Depart of VA-Health Administration Center Zoll Magellan Behavioral Health Group Health Co Blue Cross Blue Shield of Michigan Theresa Jansen United Concordia Companies Inc. X X X Thomas Garlin Tim W. McNeil Timothy L. Brown United Concordia Dental Surescripts, LLC National Association of Dental Plans Timothy W Morgan United Health Group X X X Tina Greene Mitchell WCS X Tina Olds Tish Regan Metropolitan Life Insurance Company Gateway EDI, Inc. Todd Omundson American Hospital Association X X

16 June 5, Tom E. Drinkard Mercury Data Exchange, Inc. X X X Tony Benson Blue Cross Blue Shield of Alabama X X X Tracey Mackey Tracy Moynihan Valerie Jackson Vasu Kakollu Veronica Krainik Walter Suarez CMS MSPRC - CNIAS ODTFS State of Ohio/JFS Humana Inc. Kaiser Permanente Wendy Slater Humana Inc. X X X X Total Daily Attendance