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