on April 11, 2023 at 9:00 AM

Voting Results: CLM941 - New Date DN for CA Decision to Deny a Claim


From: Gregg Lutz

User Posts: 710 -

Download Attachment IRR CLM941 - New date DN for CA decision to deny claim.pdf 91.91 kB 9 downloads
Download Attachment IRR CLM941_Claim Admin Decision to Deny.docx 14.29 kB 11 downloads

Business Requirement / Issue: Cannot track date CA denies a claim.

Requester's Proposed Resolution: New date DN for CA decision to deny claim (see attached for resolution details).

239 people saw this online 76 people saw this by email
on Nov 8, 2023 at 1:57 PM

From: Danaca Curtis

User Posts: 53 -

Good afternoon EDI Community,

When I previously posted the voting results of this IRR earlier this week I calculated the approval rate at 65% which would have meant this did not get approved as it is just shy of the 67% needed for a two-thirds majority. However, I have heard from a few people recently explaining how that calculation is incorrect because it included the abstention votes. It was also pointed out to me that in our own policy it states that abstentions should not be counted. So, if we re-calculate this and remove the abstentions this now passes at 76%.

I sincerely apologize for my misunderstanding of our policy, and the miscalculation that was originally posted. I have corrected the original voting results post to indicate it has been approved, and the relevant portion of our policy is below (last line). Thank you for all your understanding and patience in this situation, and I will absolutely be certain to triple check them in the future.

If anybody has any questions or concerns please feel free to reach out here or to me directly.

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Sincerely,

Dane Curtis

Director of Standards Development & Outreach

on Nov 7, 2023 at 11:16 AM

From: Danaca Curtis

User Posts: 53 -

Download Attachment IRR CLM941 Voting Results.pdf 54.69 kB 24 downloads

Voting for IRR CLM941 completed on November 2, 2023. The proposed resolution was APPROVED.

A total of 34 responses were received consisting of 22 "Yes" votes, 7 "No" votes and 5 Abstentions. Per the requirements of the IRR process, a two-thirds majority is required for an IRR to be considered approved. The outcome of this vote did exceed the two-thirds requirement with 76% in favor of the proposed resolution, calculated as 22 "Yes" votes divided by the total counted votes of 27 since abstentions are not counted. A detailed report of the voting results for CLM941 is attached.

on Nov 2, 2023 at 2:09 PM

From: Danaca Curtis

User Posts: 53 -

Good afternoon,

I have heard from numerous members that they did not receive the voting email. I am coordinating with other staff and vendors to ascertain why this is happening, but I wanted to post here to remind everyone that voting on this closes at the end of the day today, November 2nd, 2023. Please email me by the end of the day today if you didn't receive the voting email and still need to cast your vote, and it will be included.

Sincerely,

Dane Curtis

Director of Standards Development & Outreach

on Oct 17, 2023 at 10:14 AM

From: Danaca Curtis

User Posts: 53 -

Voting for this issue began on Thursday, October 12, 2023.

on Sept 25, 2023 at 10:22 AM

From: Danaca Curtis

User Posts: 53 -

The Final 14 Day Review period for this IRR has begun and will extend through Monday, October 9, 2023. Please respond with any final feedback or objections.

on Sept 20, 2023 at 9:14 AM

From: Monica Blackwell

User Posts: 62 -

Download Attachment IRR CLM941 - New Date DN for CA Decision to deny a claim - proposed resolution.docx 24.96 kB 6 downloads

Based on discussions at the Convention in Denver, we have added the word "Fully" to the data element name.  Please see the attached proposed resolution for the update.  

"DATE CLAIM ADMINISTRATOR DECISION TO FULLY DENY"

on Aug 16, 2023 at 2:46 PM

From: Monica Blackwell

User Posts: 62 -

Download Attachment IRR CLM941 - New Date DN for CA Decision to deny a claim - proposed resolution.docx 24.94 kB 1 downloads

Please see the new proposed resolution where a clarfication change was made to the proposed definition and DP rule.  Please review the examples provided and comment in the community if there are any questions.  This IRR will be discussed again at the Convention in Denver, CO on Sept 11th.

on Aug 14, 2023 at 11:27 AM

From: Monica Blackwell

User Posts: 62 -

Download Attachment IRR CLM941 - New Date DN for CA Decision to deny a claim - proposed resolution.docx 24.91 kB 2 downloads

Attached is the proposed resolution for this IRR.  This document also contains some examples that we plan to review in the Claims Committee meeting on 8/16/2023.  

Thank to the workgroup for all your hard work!

on Aug 8, 2023 at 1:00 PM

From: Monica Blackwell

User Posts: 62 -

Download Attachment IRR CLM941 - New Date DN for CA Decision to deny a claim_detailed notes.docx 44.80 kB 1 downloads

Attached are notes from our last workgroup meeting on 8/7/2023.  At the Claims Committee meeting on 8/16/2023, we plan to present the proposed resolution and some associated examples. 

on July 25, 2023 at 12:38 PM

From: Monica Blackwell

User Posts: 62 -

Download Attachment IRR CLM941 - New Date DN for CA Decision to deny a claim_detailed notes.docx 39.28 kB 2 downloads

The workgroup met on July 24th and attached are the notes from this meeting.  We are currently working on writing the proposed data element definition, DP Rule, and associated examples.