Implementing NEHEN has changed the way administrative processes are done in member organizations. Today, NEHEN participants already transmit all HIPAA Administrative Transactions such as:
  • Eligibility Verification
  • Specialty Care Referrals
  • Authorization / Pre-Certification
  • Referral Inquiry
  • Claim Status Inquiry
  • Claim Submission
  • Electronic Remittance
NEHEN's member subscription fees include access to the following payers:
  • Aetna
  • Blue Benefits Administration
  • Blue Cross Blue Shield of MA
  • BMC Health Plan
  • Celticare
  • Cigna
  • Connecticare
  • Fallon Community Health
  • Harvard Pilgrim
  • Health New England
  • Mass Medicaid
  • Medicare
  • Neighborhood Health Plan
  • Oxford
  • Tricare ($.05)
  • Tufts Health Plan
  • Tufts Network Health
  • Unicare
  • United
NEHEN members have an opportunity to access an extended network of ~6500 payers as an add-on service.

NEHEN also facilitates clinical data exchange, moving continuity of care documents (CCD) for the exchange of clinical discharge summaries. The content-agnostic NEHEN clinical data exchange (CDX) framework will also be leveraged for:
  • Clinical Referrals / Reasons for Referral
  • Problem Lists
  • Encounters
  • Quality data reporting
  • Immunization and syndromic surveillance reporting