2018 July Working Sessions

Date

13 Jul 2018

Attendees

Meena Jambulingam Julie MaasDiana Ciricean Carmen Smiley Paul Oates user-7c5b7 Dustin Henderson Adam Culbertson Andy Gregorowicz

Agenda

Action items

• Julie Maas to upload Sequoia white paper (added to Resources area on main page)
• Adam Culbertson to share white paper
• Meena JambulingamJulie MaasAdam Culbertson to work on creating diagram(s) for group review
• Meena JambulingamCarmen Smiley Coordinate with Security team to review scope, terminology and approaches

Group assessment of Goals 

• Problem Statement: Payers and Providers maintain different ids, making it challenging to match identities in real-time at scale. One of the ways this is tackled today is through exchange of member and provider rosters between Payer and Provider. However, this approach is impractical to implement at scale.
• In general, data attributes required to match identities are the following
  • Provider: Ids (NPI/DEA/TIN), Name (First, Middle, Last), Addresses, Facility Names, Organization details, Date of Service, Specialty/Qualifications/Titles
  • Member: Ids (SSN, Subscriber Id, Medical Record Number, Patient Id), DOB, Name (First, Middle, Last), Addresses, Gender, Phone, Email (verified or secure email ids), Emergency contacts, Parental Info (e.g. Pediatrics use cases), Previous Names/Aliases, Race/Ethnicity, Date of Service
• Anticipated Challenges
  • Resolving multiple matches in real-time
  • Dealing with scores/confidence levels for matches
• Suggested next steps
  • Analyze FHIR Resources to provide local context to Id (e.g. Member Id/MRN/NPI)
  • Compare 217s with Resources to identify gaps

Date

25 Jul 2018

Attendees

Agenda

Action items