DAC Meeting Minutes
January 8, 2001
11:30 (PST)
Roll Call
Maureen Hanna conducted the roll call .
Present: Providers/Members
Dale Clevland Reid Bellis Kim Frushon Velma Goertzen
Chuck Gunther Maureen Hanna Mike Hayden Wade Hendrickson
Dave Hosman Vickie Houghton John Kenney Herb Langsam
Laura Mc Ilvaine Sharon Nichelson Troy Paz Kim Rogers-Bowers
Carlos Reyes Gloria Peterson Rich Pozesky Val Taylor
HCFA (Seattle):
Jim Underhill
CIGNA Staff (Boise):
Melissa Atwood Dolly Baughman Carla Cerchione Lisa Fix
Doug Frazier Melissa Hansen Nicole Pichardo Dina Reynolds
Klayton Weybright Amanda Zumwalt
CIGNA (Nashville):
Dr. Robert Hoover Ellen Edenfield Dr. Doran Edwards Trisha Luna
Mary Rheinecker Shelly Tant
Carlos Reyes called the meeting to order at 11:40 a.m. (PST).
No question on the last meeting minutes.
Health Insurance Portability and Accountability Act (HIPAA)
Klayton Weybright provided an update on HIPAA. HCFA’s goal is to standardize the
electronic submission industry wide. Additional information will be sent out by e-mail.
It was agreed that the DAC EDI/EMC A-Team would schedule a conference call within
approximately 2 weeks with the CIGNA to discuss HIPAA . The focus of the call will be
to allow the Team to establish familiarity for future communication about HIPAA.
Arrangements to begin these discussions will be done by contacting the EDI Marketing
Department at 208.333.2157 (Nicole’s direct line).
A-Team leaders were given the opportunity to comment on CIGNA’s response to
questions submitted prior to the call. The following A-Teams had additional concerns:
Education/Communication, Medical Supplies, O&P, Rehab, and Respiratory.
Education /Communication (Maureen Hanna)
#2b. Maureen Hanna stated her concern over the answer. Dr. Hoover stated it was the
responsibility of the providers to keep updated. Maureen Hanna stated that most
providers don’t know what the PIM is, and that CIGNA should refer to it more often, in
the DMERC Dialogue and other provider correspondence.
#4. Maureen Hanna asked if the DAC would ever be able to get the minutes posted to
its web site. Dr. Hoover stated it should really be the DAC’s responsibility to have a web
site, as it can be very cost prohibitive, as far as space and programming and updates.
Carlos stated it is something the DAC would look into.
#8. Dr. Hoover once again stated his thanks for the offer of in-services. They usually
come from manufacturers and the nursing staff attends. Dr. Hoover stated it becomes a
scheduling problem, but the DAC is on the list.
Medical Supplies (Sharon Nichelson)
#2. Sharon Nichelson stated that the codes were off. Dr. Hoover stated he would look
into it. Dr. Hoover’s staff stated that Sharon Nichelson was correct and that all the codes
from K0428 down may be off and an update would be sent out.
Orthotics and Prosthetics (John Kenny)
#1. John Kenney stated his concern on codes, and the process for comment & review.
Dr. Hoover sated coding is separate than policy, and coding is made up of different
groups. John Kenney stated that the DAC should be part of the process. Dr. Hoover
suggested John Kenney contact Kay Riley at HCFA to get more information. Dr. Hoover
also recommended that the O&P A-Team send a letter to him and he would forward it to
the proper people at HCFA.
#2. John Kenney asked if CIGNA considers documentation provided by technicians,
therapist, etc. to be part of the physician file. Dr. Hoover stated that they look at
everything and collaboration between everything to make the proper decision.
#4. Jim Underhill still has no update on this yet.
#5. John Kenney will submit additional examples to Gloria at the DAC office who will
forward them to Dolly Baughman, CIGNA.
Rehab (Reid Bellis)
Reid Bellis announced that the DAC Rehab ‘A’ Team has developed a specialty
committee that is currently working to gather information requested by Dr. Hoover to aid
in the development of the prior authorization process. Reid thanked Dr. Hoover for the
opportunity to work on the prior authorization process.
#2. Reid Bellis stated they would put more information in writing so they can get an
answer in writing.
#3. Reid Bellis asked the percent volume cause the documentation to go up. Dr.
Hoover stated it is data driven, and they look at a lot of different data, fraud, quantity,
and billing pattern. Mary stated it is not a bad idea to send as much as you have with a
claim, especially if a chair is going to cost as much as a car.
Respiratory (Dale Cleveland)
#1. Dale Cleveland stated the DAC’s concern with HCFA Transmittal 1685, and
requested a direct contact at HCFA the DAC could address on this issue. Dr. Hoover
stated that this was not going away and is going to happen, but they have bumped the
date back. DAC stated that we would keep fighting the issue.
#4. Dr. Hoover stated to make sure to include whom the subscriber was with and will
not be retroactive, info is posted on the website.
Carla & Gloria will coordinate the dates and time of the next meeting to be held at
Medtrade West in Las Vegas, NV.
The meeting was adjourned.