2024-07-03 Patient Cost Transparency Meeting - Da Vinci (2024)

20240626 - Da Vinci PCT STU2 Ballot Reconciliation.pptx

Today, 7/3, we will come back with proposed resolutions for wording related to the connection between the Coordination Workflow & GFE Submission -Jira grouping “Submission”

Tickets aligned:

• • FHIR-45852- Misapplication of convening provider requirement
  • FHIR-45931- Delete – not established by regulation. &FHIR-45854- Issue with information flow between business actors
  • FHIR-45853- Purpose of IG
  • FHIR-45851- Clarification regarding convening provider
  • FHIR-45912- Convening provider
  • FHIR-45928- Do not presume convening provider model for insured patients

Add clarification regarding the connection between the Coordination and GFE submission workflows

• • FHIR-45868- Add guidance on GFE Collection Bundle differences for coordination workflow and submission
  • FHIR-45736- Can the Coordination Platform also send the Bundle to the Payer?

FHIR-45854 - Getting issue details... STATUS - Reviewed.

AP: Fine with the last sentence change as proposed, don't love it, but fine. Most important is adding the note. Request to strike "if implementers chose to do so." Removed.

CL: Why didn't we just leave it at the first sentence and leave out the payer part altogether.

CS: Then it might apply that it's only applicable to the self-pay, uninsured.

Side Bar: Regulations for self-pay but not yet for AEOB. There is a law. Chevron reversal impact this work? We want to continue forward as is. The statute and

The goal is to help facilitate the ability to do the work that is in the law and use of the IG is not required, but these are tools you can use.

SN: Maybe we should add that?

AP, DSC, CP don't think we need to add that, it's clear.

HM: Good with the note. To CL's point on the definition.... something like: provider is responsible for convening and getting the GFE to the patient if selfpay/uninsured. Regulation as yet to be issued clarifying the role for insured patients.

Discussion about adding a comment like "Definitions apply to this implementation guide only and there may be other definitions in other contexts, regulatory. etc." There was agreed sentiment but that the current note gets at that. Some interest to state that explicitly. Could just remove the business actors but that gets confusing. What about adding a sentence like: "For official regulatory terms, please see regulatory authorities." added something like that. Note this is on the home page, "This IG is informed by theNo Surprises Act (see Division BB, Title I, Sections 111 and 112)" so there is a connection to the Law and we don't want to dismiss that or cause more confusion. The definitions are valuable.

Agreed with the changes, no objections, marked "Ready for Vote"

FHIR-45853 - Getting issue details... STATUS - This is AP's ticket and she likes this. Take out the "by making AEOB..." Agreed with the changes, no objections, marked "Ready for Vote"

FHIR-45851 - Getting issue details... STATUS - Commenter agreed with the changes, no objections, marked "Ready for Vote"

FHIR-45912 - Getting issue details... STATUS - Commenter agreed with the changes, no objections, marked "Ready for Vote"

FHIR-45928 - Getting issue details... STATUS - With the changes to the definitions and note added, this now looks fine to commenter. No objections, marked "Ready for Vote"

FHIR-45852 - Getting issue details... STATUS - Reviewed. Corey reviewed the whole IG and made recommendations to align with the other ones. Added "Optionally..." AP liked that. Section 3 Coordination Overview.

Remove the following sentence:

Good Faith Estimate (GFE) Bundle includingGood Faith Estimate resource profiles(Claim resources of type predetermination) along with supporting data (such as Patient, Coverage, etc.) to a payer. The payer can then use this information to generate an Advanced Explanation of Benefit (AEOB) Bundle includingAdvanced Explanation of Benefits resource profiles(ExplanationOfBenefit resources of type predetermination) along with supporting data that the patient, and optionally the provider (GFE submitter on claim resources), can retrieve to get an estimation of costs for expected services as known at a specific point in time.

Action: Vanessa see if we want this paragraph added to the Submission section instead of just removing completely. If so, add a ticket.

Discussion on the "Note: This IG does not require GFE coordination to take place in order for providers to submit GFEs to payers, nor does it require the output of the GFE coordination be submitted to a payer." - BCBSA wanted to call out the concern here that it feels like a If the regulation

Final Proposed Resolution, No objections, marked "Ready for Vote"