Group Minutes X12N TGB/WG10 Services Review January 30 Feb 2, 2017 Seattle, WA Group Leadership Chair Name Company Term End Date Phone Email Bruce Bellefeuille Aetna June 2017 870-879- 2648 BellefeuilleBR@Aetna.co m Diane Franks Health Net Federal Services January 2019 916-985- 5876 Diane.e.franks@healthnet.com Kimberly Young TransUnion June 2017 704-970- 1424 kyoung@transunion.com Secretary Name Company Term End Date Phone Email Theresa Doris Tibco NA 850-714- tdoris@tibco.com 7189 Quorum Requirement Statement (Check appropriate statement for your group) This group enforces quorum requirements for group voting items. Note here if Quorum has been met This group does not enforce quorum requirements for group voting items. X Scheduled Meetings Type of Meeting Date Location/Call in Contact Agenda (high level items to be covered full agendas should be posted prior to the meeting) Seattle, WA Current Meeting 1/30/2017 to 2/2/2017 Next Standing Meeting Interim Meeting Management Meeting 06/04/2017 to 06/08/2017 2nd and 4 th Fridays 1:00 2:30 EST (Will not be meeting on 4/14/17, or 5/26/17) Thursdays 12:00 EST San Antonio, TX 605-475-5950 passcode 5770287 CRs TR3 examples 7030 Work - Input and Call Topics for remaining change requests - Pre-public Guide Reviews - Public Comment preparation - Finish CR s for moving 278/275 examples to External library Revised 01/2016 Page 1 of 5
Chair Elections Candidate(s) Diane Franks Nomination Nominated by LuAnn Hetherington Seconded by Bruce Bellefeuille Vote Approved by unanimous consent Discussion No discussion Results Diane Franks was re-elected for another 2 year term ending Jan 2019. Voting Items Type Issue Description Minutes Approve Minutes from September 2016 standing meeting Motion Vote Motion Made by 2 nd By Approve Disapprove Abstain Diane Franks Theresa Doris 10 0 0 Discussion No discussion Summary of Discussion - CR1543 Correction to BRTS document Bruce identified a problem in the approved BRTS when calling topics. In backtracking to the root cause here is my analysis. Below is the actual business requirement which was approved. The From and To wording was not correct as what should be used for the Inquiry (X264). The correct From statement should have been: Use to limit the inquiry to information on requests for admission to a facility. B1.9 2369 The code note for value AR will be changed from Required if requesting an admission to a facility. to Use when requesting an admission to a facility. in the X264 REQ 2000E UM UM01 The Technical solution correctly indicated the From statement for the Inquiry when HLEV UM01=AR. However the To statement was not correct for the Tech solution even though it was approved by the WG voting process. In speaking with the workgroup the correct Tech solution for the To statement for this topic should be: Use when needed to limit the inquiry to information on requests for admission. Current Tech solution requirements are below: T9. Modify Unique Code Note 2369 on Code Value AR (Admission Review) on the Transactions, Segments and Data Elements identified below: [B1.9] Revised 01/2016 Page 2 of 5
Healthcare Services Review - Inquiry and Response (278) (successor to 006020x264) 278 Inquiry Loop ID-2000E (Patient Event Level), UM01 From: Use to limit the inquiry to information on requests for admission to a facility. To: Use when requesting an admission to a facility. Per Kelly we should withdraw the topic and address the change during public comment. Informational Forum or Joint Meeting Notes Topic Date/Time Service Type Code Collaboration with WG1 2/1/2017 10 am -12 pm Summary of Discussion - X12 management felt like having a single all inclusive solution with all service type codes broken down in the database as originally suggested may not be the best approach for entities that download the master file and then have to parse out what codes would be used for eligibility versus Health Services vs Benefits etc. It made more sense to have a master file but break the file into subsets so it would be easier to just download the subset file for 278 use vs 270/271 use etc. - If the subset approach is taken and will be utilized for the 7030 version then expedited decisions will need to occur due to TR3 changes will be needed to point to the correct subset of the external code list. - WG1 and WG10 will still need to work collaboratively on any new STC codes - Pre-code meetings will still be needed to insure that the code values being requested are meaningful for the industry. - TGB management will be looking at the end solution quickly as to what suggested changes will occur and will work with the respective workgroups to insure any 7030 changes are completed to make the public comment period. Change Requests needed for 278/275 examples for external library CR1584 (Additional Information to Support a Health Care Services Review (275) Update Examples for version 7030 on external website ) CR1585 (Healthcare Services Review - Request for Review and Response (278) Update Examples for version 7030 on external website ) CR1586 (Healthcare Services Review - Notification and Acknowledgement (278) Update Examples for version 7030 on external website ) CR1587 (Healthcare Services Review - Inquiry and Response (278) Update Examples for version 7030 on external website ) - The current 278 and/or 275 examples in the external library are out dated and need to be updated to reflect a 7030 version - The dates should also align with current dates and the wording descriptions should mirror with the Revised 01/2016 Page 3 of 5
dates in the segment examples. - It makes sense to take out any references to ICD9 since ICD10 has been mandated at this time. There were comments made that back dating requests is still a common practice and might be applicable with some workflows. However that may be true but it is not in the common workflow so let s not support it in our examples - CR1585 will need more time to complete since it has many different examples that will be used - The format of the current examples is very hard to work with in the word document. We may want to consider to possibly using a different format for the examples. OR we may just rely on the publisher to clean up the format so it can be cleaner from a visibility perspective. - We should be thinking of existing workflows used today and provider examples for those common industry practices and/or think of what is on todays National Precert Lists and use those for scenarios. Review of Guides before Public Comment Period/other Public Review items There are concerns that there may not be enough time to complete a page turning exercise for each of the 278 guides before the start of the Public Comment period. - There may be a very realistic chance that the publisher will not be able to complete all of the guide work needed in time for review before the beginning of public comment period. - We will most likely need volunteers to work on these reviews independently or in small workgroups in between the interim calls. - The Co-Chairs will evaluate and come up with an action plan if these scenarios develop. It is most certain that additional interim calls will be set up so that WG10 can accomplish all public comment period requirements. TRN versus PWK in 278 vs 275 transactions It is very confusing to the industry to see 2 segments named differently and being used for the same data. The 278 uses the PWK06 to return the Attachment Control number when requesting additional information. However the 275 to support health care services, uses the TRN to relay the PWK06 value. It is even more confusing due to the TRN in the 278 is used for tracking as well but not for the requesting of additional information. Why can t they both be a PWK segment? We believe the 275 for claim uses the PWK segment so why doesn t the 275 used for Precert/Referrals use a PWK? WG10 will put in a public comment to have the 275 for Precert/Referral change the RN segment to mirror the PWK as for what is used in Claims Revised 01/2016 Page 4 of 5
Confusing that a member name cannot be returned in 278 response It was confusing when reviewing the member NM segment response details that indicates the name should not be returned if it was not submitted with the request. - The WG did not necessarily all agree to the current situational rule that that the name should not be returned if not submitted with the request - The front matter does indicate that it really is a UMO decision as to what details are needed to identify the patient: The maximum data elements that the UMO can require to identify the subscriber, in addition to the member ID, are as follows: Subscriber Last Name (NM103) Subscriber First Name (NM104) Subscriber Birth Date (DMG01 and DMG02). - WG felt it is important that the name should be returned so that there is a validation that the request submitted is for the Name/ID/DOB that is returned in the response (even though an ID# may have been the only data received in the request. - Some WG members also felt multiple data is needed so that verification process is more accurate. - More discussion may be needed but either a public comment might be entered or a new change request will be needed. Revised 01/2016 Page 5 of 5
TGB WG10 January 2017 Standing Meeting Session Name Date Full Name Company N B 10 - Services Review Info Wk Grp 2017-01-30 Belen, Aileen Kaiser Permanente N B 10 - Services Review Info Wk Grp 2017-01-30 Bellefeuille, Bruce Aetna Inc. N B 10 - Services Review Info Wk Grp 2017-01-30 Boyland, Stephanie US DOD-Health Affairs Inf Mgt Office N B 10 - Services Review Info Wk Grp 2017-01-30 Doris, Theresa Tibco N B 10 - Services Review Info Wk Grp 2017-01-30 Franks, Diane US DOD-Health Affairs Inf Mgt Office N B 10 - Services Review Info Wk Grp 2017-01-30 Hetherington, LuAnn Highmark Inc. N B 10 - Services Review Info Wk Grp 2017-01-30 Hogan, Claire Cerner Corporation N B 10 - Services Review Info Wk Grp 2017-01-30 Jones, Gladys OneHealthPort N B 10 - Services Review Info Wk Grp 2017-01-30 Meisheid, Anna CMS/HHS N B 10 - Services Review Info Wk Grp 2017-01-30 Peterson, Amy Humana Inc. N B 10 - Services Review Info Wk Grp 2017-01-30 Smith, Jeanie Florida Blue N B 10 - Services Review Info Wk Grp 2017-01-30 Tyra, Mary US Department of Veterans Affairs N B 10 - Services Review Info Wk Grp 2017-01-30 Vowels, Melissa Humana Inc. N B 10 - Services Review Info Wk Grp 2017-01-30 Young, Carol CMS/HHS N B 10 - Services Review Info Wk Grp 2017-01-30 Young, Kimberly TransUnion Healthcare N B 10 - Services Review Info Wk Grp 2017-01-31 Belen, Aileen Kaiser Permanente N B 10 - Services Review Info Wk Grp 2017-01-31 Bellefeuille, Bruce Aetna Inc. N B 10 - Services Review Info Wk Grp 2017-01-31 Doris, Theresa Tibco N B 10 - Services Review Info Wk Grp 2017-01-31 Franks, Diane US DOD-Health Affairs Inf Mgt Office N B 10 - Services Review Info Wk Grp 2017-01-31 Hogan, Claire Cerner Corporation N B 10 - Services Review Info Wk Grp 2017-01-31 McComas, Heather American Medical Association N B 10 - Services Review Info Wk Grp 2017-01-31 Meisheid, Anna CMS/HHS N B 10 - Services Review Info Wk Grp 2017-01-31 Peterson, Amy Humana Inc. N B 10 - Services Review Info Wk Grp 2017-01-31 Schulte, Ginger Group Health Cooperative N B 10 - Services Review Info Wk Grp 2017-01-31 Thompson, Sue Nat'l Council for Prescription Drug Prog. N B 10 - Services Review Info Wk Grp 2017-01-31 Tyra, Mary US Department of Veterans Affairs N B 10 - Services Review Info Wk Grp 2017-01-31 Young, Kimberly TransUnion Healthcare N B 10 - Services Review Info Wk Grp 2017-02-01 Belen, Aileen Kaiser Permanente N B 10 - Services Review Info Wk Grp 2017-02-01 Bellefeuille, Bruce Aetna Inc. N B 10 - Services Review Info Wk Grp 2017-02-01 Boyland, Stephanie US DOD-Health Affairs Inf Mgt Office N B 10 - Services Review Info Wk Grp 2017-02-01 Burckhardt, Laurie WPS Insurance Corp. N B 10 - Services Review Info Wk Grp 2017-02-01 Doris, Theresa Tibco N B 10 - Services Review Info Wk Grp 2017-02-01 Franks, Diane US DOD-Health Affairs Inf Mgt Office
TGB WG10 January 2017 Standing Meeting Session Name Date Full Name Company N B 10 - Services Review Info Wk Grp 2017-02-01 Hetherington, LuAnn Highmark Inc. N B 10 - Services Review Info Wk Grp 2017-02-01 Hogan, Claire Cerner Corporation N B 10 - Services Review Info Wk Grp 2017-02-01 Peterson, Amy Humana Inc. N B 10 - Services Review Info Wk Grp 2017-02-01 Smith, Jeanie Florida Blue N B 10 - Services Review Info Wk Grp 2017-02-01 Young, Kimberly TransUnion Healthcare N B 10 - Services Review Info Wk Grp 2017-02-02 Bellefeuille, Bruce Aetna Inc. N B 10 - Services Review Info Wk Grp 2017-02-02 Doris, Theresa Tibco N B 10 - Services Review Info Wk Grp 2017-02-02 Franks, Diane US DOD-Health Affairs Inf Mgt Office
TGB WG1 with WG10 January 2017 Standing Meeting Session Name Date Full Name Company N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Beaton, Stuart Stuart Beaton, IM N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Belen, Aileen Kaiser Permanente N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Bellefeuille, Bruce Aetna Inc. N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Billhartz, Peggy Cognosante, LLC N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Boyland, Stephanie US DOD-Health Affairs Inf Mgt Office N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Burckhardt, Laurie WPS Insurance Corp. N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Campbell, Donna Health Care Service Corporation (HCSC) N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Chewning, Christina Availity, LLC N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Coughlin, Peter International SOS Inc N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Dorio, Aggie Aetna Inc. N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Doris, Theresa Tibco N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Franks, Diane US DOD-Health Affairs Inf Mgt Office N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Harris, Mark Centene Corporation N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Hayden, Megan Surescripts, LLC N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Jamison, Sandra Humana Inc. N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Jones, Gladys OneHealthPort N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Jonzzon, Kathy Delta Dental Plans Association N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 McCachern, Deborah Change Healthcare N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 McJannet, Kate Premera Blue Cross N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Onimus, Buddy Cerner Corporation N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Ortega, Beth Hewlett Packard Enterprise N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Peterson, Amy Humana Inc. N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Rehwoldt, Greg U.S. DOD-Health Affairs Information Management Office- TRICARE N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Rude, Diane Blue Cross Blue Shield Association N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Sanchez-Caro, Nancy Nancy Sanchez-Caro, IM N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Semataska, Evelyn Aetna Inc. N B 01 - Benefit Info Wk Grp - w/ N B 10 2017-02-01 Senato, Nancy Aetna Inc.