The New England Healthcare Exchange Network grew from a simple exchange of patient eligibility information in
1998 to a mature HIE encompassing all HIPAA-standard administrative transactions as well as emerging clinical data
The benefits of using NEHEN's solutions for administrative and clinical data exchange are manifold, from
enhancing the quality, safety, and efficiency of care, to reducing costs, to gaining operational efficiencies
from streamlining disparate technical processes for interchange and mandated report delivery.
Members of NEHEN who are providers have gained benefits from using NEHEN for:
Single Eligibility Verification Process for Any Payer
With NEHEN, provider organizations have a single process and system for checking eligibility with multiple health
plans. They have the flexibility to fully integrate eligibility verification into their hospital information system
or use NEHEN's own Web-based application to inquire on every patient that walks in the door.
NEHEN has dramatically reduced rework, improved collections, and enabled a higher degree of customer service
and patient interaction at registration.
Automation of the Inquiry Process
Using NEHEN's batch functionality, providers automate their eligibility verification process by building an
extract out of their scheduling/registration system to automatically check eligibility for all scheduled patients
in advance. Later, they work the few exceptions where the insurance information in their system does not match the
payer system. By checking eligibility beforehand, providers have the opportunity to correct insurance discrepancies
before the patient arrives for their appointment.
Providers also use NEHEN's batch functionality to automatically inquire on all unpaid claims by extracting a file
directly out of the provider billing system and working the exceptions the following day. This acts as an alternative
to inquiring on one claim at a time by calling the payer directly or using payer Web-sites.
Automating Coordination of Care Activities
The time and cost of sending patient discharge and encounter summaries to a patient's next setting of care can be
too high to justify for many providers. As a result, not only does continuity of care suffer but also efficiency
of the entire healthcare system suffers as providers order redundant tests and perform redundant treatment.
NEHEN helps providers automate the process of sending clinical summaries to a patient's next caregiver, achieving
both cost savings and quality improvement.
Automating the Claim Submission Process
NEHEN gives providers a single point to manage and track major claim volume often replacing many proprietary
direct submissions with an automated claim submission process including:
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File Transmission which automates sending claim batch files to payers and receiving response files from
payers including support for sending claims to Medicare, Medicaid and clearinghouses (for non-NEHEN payers).
File and Claim Tracking with a centralized repository of sent claims, functional acknowledgements,
and application acknowledgements on the provider side.
Report Viewing that includes an online repository of payer-generated submitter reports from claim