As an attendee of the X12 Winter Meeting this January, I noticed a difference compared to previous conferences. This year the primary focus was legislation, reviving past and pending transactions and standards legislation, and creating new legislative initiatives. There was discussion around the 5010 Standard currently in place that was mandated 13 years ago. That Standard is 20 years old now and is required only for a limited number of transactions.
UHIN Comments and the Path Forward
UHIN has spent a lot of time developing comments and reviewing the different options for moving forward with the currently pending version of the proposed rule for pre-auth for the 6020 Standard. That rule is officially known as “Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard.”
X12, WEDI, and Cooperative Exchange have each proposed solutions to help move this forward. What has been clear from all the industry groups is without a mandate, standards are further delayed, and if history repeats itself, the current proposed change will likely be out of date before it can be mandated.
How Payers Could Get Ahead of the Curve
Understandably, there’s hesitation to adopt a rule that’s not yet mandated. The current discussion would mandate the 6020 standard that is currently part of the proposed rule. However, payers may want to consider whether beginning implementation anyway could be the right course for them. There are advantages to doing so, including allowing operations to track closer to what we believe are best practices for your business. A methodology pivot may be necessary after the final rule is in place, but you’d be ahead of the curve.
In its fact sheet on the rule, CMS cites research by CAQH, which finds healthcare industry savings of $828 million per year could be achieved from the adoption of automated electronic processing of claims, including prior-auth and attachments. Of course, an industry-wide standard is a key pillar in supporting automation.
Clarification on Paper Claims
The federal government appears to be using prior-auth as a carrot to encourage providers to cut the fax and snail mail cords. CMS has published a helpful fact sheet on the rule. In the FAQs, it explains that providers who submit paper requests for pre-auth to payers are not subject to this HIPAA rule but, “The provider would be a covered entity if their paper claims were submitted to a health care clearinghouse or a billing service, and, on behalf of the provider, that health care clearinghouse or the billing service transformed them into standard electronic transactions and transmitted them to a health plan.”
The comment period for the currently pending attachments and prior-auth rule for the 6020 standard will close on March 21, 2023.
Working Toward a Universal Language
The best standards are those that scale. We think the currently proposed rule is an important step toward a universal language for interchange, and we look forward to moving 278s in a standard fashion in the future.
UHIN has been implementing standards since 1999, starting with the first national standard 4010, and continues to be the leader in Utah in setting standards. We work with both health plans and providers to better understand pending legislation and standards.
If you’re interested in the output of our committee, which sets standards for all of Utah, click here to view our library on the UHIN Knowledge Center. You can reference a variety of information, including payer responsibilities associated with the current standards.
By Boyd Kreeck, Senior Technical Business Analyst, UHIN
Health plans could save billions each year by accelerating administrative efficiencies for themselves and providers. A new CAQH report breaks down the opportunities and showcases the value of a clearinghouse partner as electronic data interchange (EDI) becomes the norm. Working with a trusted clearinghouse partner – one who knows the complexities of today and tomorrow – will help you navigate the future.
A Decade of Success Reporting on a Digitally Enabled Administrative Environment
Administrative transactions, including benefit and eligibility checks, prior authorizations, and claim processing, form the backbone of the entire healthcare system. Health plans and providers must be able to conduct these EDI transactions in a swift, secure, and standardized manner to enable delivery of timely and informed care.
CAQH, a non-profit alliance of health plans and their partners, has tracked adoption of electronic transactions every year since 2013. The most recent edition chronicles a decade of commitment to digitizing administrative processes and strengthening EDI connections between disparate systems in the payer and provider environments. The adoption of many electronic transactions has increased, such as claims submissions, eligibility and benefit verification, and acknowledgements.
Automation is the key to getting it right. Throughout the past decade, the use of EDI has skyrocketed by 25 percent, according to the latest edition of the CAQH Index Report. Now, nine out of every ten transactions take place digitally, reducing industry-wide operating costs by approximately $187 billion every year.
Despite this progress, there are still opportunities for health plans to control costs, maximize resources, and trim the time it takes to conduct the business of healthcare. Certain critical processes have a long way to go, like prior authorization and attachments.
Currently, only 28 percent of PAs are being exchanged digitally while the electronic submission of attachments that support medical claims is similarly low, starting at 6 percent in 2016 and only rising to 24 percent by 2022.
During the coming years, health plans will need to reexamine their current workflows to boost the use of digital strategies for sharing documents and data with their provider partners, particularly as transaction volumes have risen 28 percent since the COVID-19 pandemic, paired with a 47 percent increase in overall medical spending.
Experienced and trusted clearinghouses will be central to success. Clearinghouses make it simple for plans and providers to share information and collaborate around patient care, creating the right environment for the smooth and seamless exchange of vital administrative data.
Uncovering Opportunities to Reduce Burdens in Key Administrative Areas
The positive results so far have saved hundreds of billions for health plans, as well as an average of 14 minutes per transaction for medical care providers. But addressing these notable areas of opportunity and transitioning fully to EDI could produce a further $25 billion in cost reductions, representing 41 percent of the current spend.
Specifically, health plans can focus on the following areas to trim their budgets and provide relief to payer and provider staff members:
Eligibility and benefit verification: Representing the highest proportion of annual spend, health plans could save up to $12.8 billion if they work with providers to digitize the 10 percent of transactions that remain manual. Closing the gap will be crucial for sustainability as the volume of transactions continues to increase.
Prior authorizations (PAs): A well-known pain point across the industry, PAs are time consuming and complicated to submit manually. The medical industry could save close to $450 million per year by creating more automated and streamlined PA processes, not to mention trimming 11 minutes per transaction off of a provider’s daily calendar.
Claims submissions: As the volume of medical services increases, so too will the claims for reimbursement, adding to the $11.1 billion industry spend. CAQH points out that training staff to conduct electronic claims submissions can take time and money, so beginning the adoption and education process now, before volumes exceed current norms, will be important for achieving savings and maximizing staff productivity.
Attachments: Supporting information for reimbursements is rarely sent electronically, creating a $213 million annual savings opportunity. CMS recently proposed standardsfor these transactions to help guide adoption and simplify data exchange.
Claims status inquiry: Payers and providers are spending 50 percent more on claims check ups as margins remain slim following the pandemic. Broadening the automation of claims status updates could help the industry save $3.6 billion a year, plus 15 minutes per transaction for providers. A clearinghouse solution with automated features can help to achieve this goal for plans and their partners.
Remittance advice: Similar to claims status inquiry, automating the delivery of remittance advice could save medical care stakeholders up to $2 billion a year by increasing efficiency and reducing time spent on phone calls and follow-ups.
Capitalizing on these transactions to reduce spending and staff burdens will be important for health plans as the volume of medical transactions is expected to continue to increase.
While there are small spending increases associated with adopting digital transaction tools, the savings far outweigh the required investment, CAQH states. Automating these processes can produce further cost reductions by avoiding the need to attract and retain larger workforces, especially as qualified staff are now in short supply.
Leveraging Clearinghouses to Achieve Administrative Efficiency
Clearinghouses make all of these transactions possible, so health plans will need to evaluate their existing capabilities, and find the right partner, if necessary, that offers a tested and sophisticated approach to automation if they wish to take advantage of these savings opportunities.
Plans should look for clearinghouse solutions that have deep experience and an exceptional reputation for reliability, agility, and standards-based collaboration between disparate trading partners.
Health plan leaders should also conduct thorough internal reviews of their established workflows – and work closely with their contracted providers to understand their processes and frequent problems, too – in order to identify potential areas of improvement. Next, they should seek out a clearinghouse partner with capabilities to fill in those gaps and accelerate savings in time, staffing, and operational spending.
By adopting more modernized digital clearinghouse solutions with the capacity to streamline communications and complete tasks in a quick and trustworthy manner, health plans can begin to take advantage of everything that EDI has to offer.
Preparing for the Future of EDI
In just a few years, plans that proactively embrace electronic transactions at scale can position themselves for significant cost reductions, fewer burdens for staff, and better administrative experiences across the entirety of the care continuum.
The right clearinghouse partner will proactively work with plans to develop a tailored roadmap to greater EDI adoption, help staff to maximize their productivity in this new ecosystem, and stay on top of evolving federal regulations guiding the evolution of electronic transactions.
With a 30-year history of helping health plans accelerate the adoption of electronic transactions, UHIN has been instrumental in creating a more cost effective, less burdensome future for critical information exchange. Our experts meticulously evaluate the needs of each of our partners and work with leaders to create a customized plan for expanding EDI activities with an eye toward improving efficiency across the enterprise.
As more and more administrative transactions go digital, health plans can’t afford to be left behind. Get started today with a consultation with our experienced team.
Navina Forsythe, MPA, Ph.D., has joined UHIN as our first Chief Data Officer. Dr. Forsythe most recently served as Director of the Center for Health Data and Informatics at the Utah Department of Health. Dr. Forsythe has a Ph.D. in Psychology and a Master’s in Public Administration from the University of Utah. In this new role, she will accelerate UHIN’s efforts to strategically leverage data for client success, and empower interoperability for good across the healthcare spectrum.
As Chief Data Officer, Dr. Forsythe will further UHIN’s mission to support the collaboration of care for patients by providing the right information at the right time in the right format so healthcare professionals may provide the best possible care to patients.
Dr. Forsythe will oversee the development of data and analytics to establish a consistent, coherent approach throughout UHIN, and will tie analytics into all facets of the company. As businesses change and new types of data become available, she will lead efforts to connect the many participants in the healthcare ecosystem to the need for interoperable data and data sharing.
“Navina will help us advance our efforts in leveraging our data management infrastructure by designing curated experiences for the entire organization that map data in ways that inform business choices, and move the power of data into the hands of our healthcare community members. In short, our focus is to give more value through informed insights and actionable information.”
Brian Chin, CEO
Dr. Forsythe is ardently dedicated to data privacy and considers the safeguarding of privacy to be fundamental in all that UHIN does. She is a Certified Information Privacy Manager (CIPM) and served as the Chair of the Institutional Review Board at the Utah Department of Health and Human Services. UHIN is EHNAC accredited and SOC 2 compliant.
Dr. Forsythe has over three decades of experience in health and social services government agencies including clinical work, technology and information systems management, and data management.
As a clinician, Dr. Forsythe has conducted neuropsychological, psychological, cognitive and achievement assessments, provided therapy, group sessions, and cognitive remediation.
As a technology manager, she has overseen development and maintenance of multimillion dollar case management information systems and worked with the Utah Digital Health Services Commission to update and maintain the Utah State Health Information Technology Strategic Plan.
As a Chief Data Officer, Dr. Forsythe has overseen the development of reporting systems and provided information for assessment, policy decision making, process and outcome evaluation, and program improvement.
Every patient deserves a full, dynamic portrait of their care story. We believe in our power to create a more vibrant and complete picture together.
The HIT Conference will feature four tracks with sessions covering topics like population health, interoperability, care delivery, and health equity, as well as popular sessions from previous PES conferences, like “Medicare Hot Topics” with Lori Weber and the Payer Panel. Join other healthcare professionals and attend sessions by esteemed speakers from the State of Utah, Office of the National Coordinator (ONC), University of Utah Health, Amazon Web Services (AWS), Noridian Healthcare Solutions, BYU, AUCH, Comagine, SLCo Health Department, UHIN, and more to be announced!
This event is tailored for professionals across the healthcare ecosystem, such as CEOs, CTOs, CIOs, Chief Medical Officers, VPs, directors, doctors, nurses, administrators, office managers, billers, educators and many more roles at health plans, hospital systems, providers, clinics, higher education institutes, and nonprofit organizations.
PES at HIT
For the first time ever, we’ve combined the annual Provider Education Summit (PES) and the HIT conference into a one-day, hybrid event. PES is an educational event for health plans and providers, billers, office managers, coders, administrators and more. PES will have a dedicated track, Provider Education, at the HIT conference this year.
Welcome Keynote
Rich Saunders
Chief Innovation Officer, Utah
Rich Saunders is Utah’s first chief innovation officer and is charged to help lead the Cox-Henderson administration’s commitment to aggressively upgrade state government efficiencies, innovations, and responsiveness to Utah residents, including a world-class customer experience initiative, and organizing the One Utah Health Collaborative nonprofit. Rich previously served as the executive director of the Utah Department of Health during the COVID-19 pandemic, and before state government, was an entrepreneur for 25 years with extensive experience in multiple verticals and significant sales networks nationwide. Rich has an ongoing passion for leadership, knowledge, organizational health, and service to his community.
Closing Session
Brittany Bowe
Olympic Speed Skater and Medalist
Three-time Olympian, Two-time Olympic medalist, 1,000-meter world record holder
Brittany Bowe led the way for Team USA as the flag bearer for the 2022 Winter Olympic Games in Beijing. She is a Three-time Olympian and Two-time Olympic medalist who gave up her spot in the 500m at the 2022 Winter Olympic Games for Teammate Erin Jackson – recognized as one of the most selfless acts in Olympic history.
1,000-meter world record holder… Reigning 1,000-meter season-long world cup champion… Won seven consecutive 1,000-meter world cup races from December 2018 to December 2019, the longest win streak by a U.S. woman. She helped end a 12-year U.S. women’s drought with an Olympic bronze medal in the team pursuit, and finished top-five in all four of her races at the 2018 Olympics. She is also a Six-time world champion, 20-time world championship medalist and 73-time world cup medalist.
As a gay athlete and LGBTQ+ advocate, uses her platform to promote inclusion and support others. She volunteers as an ambassador for nonprofits Right to Play and Athlete Ally.
Brittany suffered a concussion while training for the 2018 Olympics and was diagnosed with POTS, which means the body does not control blood pressure or heart rate after you stand up. She overcame her fear from that setback and, through an aggressive rehab program, returned to the podium.
Brittany previously played college basketball at Florida Atlantic University and won 32 world championship medals in inline skating before switching to ice. She is dedicated to maintaining a healthy balance between the physical, mental and spiritual aspects of life, and is working toward her yoga teacher certification. Also, Brittany is a cat owner.
Motto: “Practice doesn’t make perfect, perfect practice makes perfect!”
Tracks and Speakers
10:00 a.m. “A Novel Outpatient Complex Care Model – Using Claims Data for Risk Stratification and Evaluation” Dr. Peter Weir | Executive Medical Director of Population Health, University of Utah Health
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A review of the Intensive Outpatient Clinic – highly coordinated and integrated care for Medicaid members with complex mental and medical health problems that result in high utilization.
11:00 a.m. “Partnerships to Increase HPV Vaccine Rates for Utah’s Community Health Centers” Shlisa Hughes | Quality Improvement Director, AUCH
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AUCH is committed to preventing HPV related cancers through improving HPV vaccination rates. AUCH has partnered with Huntsman Center for HOPE, the U of U, Huntsman Cancer Center, the American Cancer Society and the UDHHS, and Utah’s Federally Qualified Health Centers to use automation and interoperability with clinical workflows to improve immunization rates for Utah’s youth. We will share results and innovations from across the state.
Kassy Keen, MPH | Health Equity Bureau Manager, Salt Lake County Health Department
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Health equity has gained increased attention, resources, and support as COVID-19 and social justice movements transform our communities. Often we discuss health equity frameworks, which can be abstract and confusing, offering little guidance around implementation. So, what does it look like to incorporate health equity into systems, programs, and policies in the medical and health field? In this presentation, we will discuss operationalizing health equity, and explore a broad scope of tangible ideas to build capacity, and instill new processes, procedures, and data to create better outcomes for our communities.
2:00 p.m.Orion Health Presentation Chad Peterson | Chief Revenue Officer, Orion Health
3:00 p.m. “Using Analytics to Improve Personal and Population Health“ Sara Hallvik | Vice President of Data Solutions, Comagine Health
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Health data can be a powerful tool in improving both personal and population health, but one must consider several factors first. Data governance determines who and how data is used. Data quality determines whether results can be trusted. Combining data sources increases the complexity but can also increase the power of the data. This opens the way to descriptive, predictive, and prescriptive analytics, where one can harness their data’s true potential.
10:00 a.m. “Why Are We Still Challenged by Identity Matching and Data Quality?Follow Oscar’s Patient Journey” Gregg Church | President, 4medica, Inc.
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Access to accurate, complete, and timely data is one of the most valuable assets in any healthcare organization. The push toward value-based care and population health initiatives including the response to COVID-19 have amplified the need for efficient exchange of quality patient data, filling gaps in information and offering providers and payers a more complete picture of the patient. Quality data improves care coordination, clinical outcomes, and saves lives but can only be achieved with accurate patient identification or matching across multiple sources.
Learning Objectives:
The need for exchanging reliable clinical and administrative data in “real time” for better care coordination and population health management
How patient data is being exchanged securely and reliably for care coordination decisions
How HIE’s and health networks use quality health data to exchange and provide ‘actionable’ data insights in and out of their community
11:00 a.m.“Setting Utah’s Standards: You Hold the Power” Boyd Kreeck | Business Analyst, UHIN
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The UHIN Standards Organization is a nonprofit, broad-based coalition of Utah healthcare insurers, providers, and others, including local government entities. The purpose of the Standards Committee is to develop administrative, technical, and billing standards and specifications based on existing federal and state regulation.
Standards created by the committee and approved by the UHIN Board are provided to the Utah State Department of Insurance, Utah Health and Human Services and published in State Rules and made available to the public at UHIN.org. In addition to developing Utah Standards, the UHIN Standards Committee participates in the development of National standards and guidance.
1:00 p.m. “The Present and Future of HIEs“ Michelle Suitor | Director of the Clinical Health Information Exchange, UHIN
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A discussion on the history of interoperability and an overview of the various standards covered from both the claims and clinical standpoint. This session will explore what that means for Utah, and provide examples of specific use cases.
2 p.m. “Coordinating and Aligning Health IT: An update on nationwide health IT and interoperability goals” Micky Tripathi, Ph.D., M.P.P. | National Coordinator for Health Information Technology, the U.S. Department of Health and Human Services
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Join ONC’s National Coordinator Micky Tripathi for updates on:
ONC’s work to align health IT activities across HHS agencies
How the Trusted Exchange Framework, Common Agreement (TEFCA) will ease information sharing across networks of EHRs and other health IT systems
The continued implementation and enforcement of the information blocking regulations
Data standardization efforts to promote equity, reduce disparities, and support public health data interoperability
And more!
3:00 p.m. “HIE Transformation: It’s About More Than Data“ Mary-Sara Jones | Sr. Business Development Executive, Health & Human Services, Amazon Web Services (AWS)
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The Public Health landscape is changing. It is getting broader and deeper. The global pandemic highlighted fragmentation across and within organizations and the incompleteness of the data available to decision makers. There is a hunger for better, richer, cleaner data to support more holistic decisions and move efforts toward prevention. For many states data modernization and digital transformation will occur in parallel. Immediate updates to shared data infrastructure can provide meaningful insights while updated paradigms of service delivery are reimagined with modern technology to better meet provider and constituent expectations. Health Information Exchanges play a central role in creating and maintaining a connected data ecosystem driving improved patient outcomes and community vitality. This presentation with Natasha Nicolai explores future models for HIEs, how data transformation can provide immediate community impact, and what is required to create the parallel path to digital transformation.
3:00 p.m. “HIE Transformation: It’s About More Than Data“ Natasha Nicolai | AWS WWPS SLG Leader, Health and Human Services Analytics, Amazon Web Services (AWS)
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The Public Health landscape is changing. It is getting broader and deeper. The global pandemic highlighted fragmentation across and within organizations and the incompleteness of the data available to decision makers. There is a hunger for better, richer, cleaner data to support more holistic decisions and move efforts toward prevention. For many states data modernization and digital transformation will occur in parallel. Immediate updates to shared data infrastructure can provide meaningful insights while updated paradigms of service delivery are reimagined with modern technology to better meet provider and constituent expectations. Health Information Exchanges play a central role in creating and maintaining a connected data ecosystem driving improved patient outcomes and community vitality. This presentation with Mary-Sara Jones explores future models for HIEs, how data transformation can provide immediate community impact, and what is required to create the parallel path to digital transformation.
10:00 a.m. “Beating Hypertension, the Silent Killer“ Nickee Andjelic, MS, CHES | Maternal and Infant Health Program Manager, Utah Department of Health and Human Services
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The Utah 6|18 Workgroup is a cross-collaborative workgroup focusing on addressing 6 high-cost and preventable health conditions with 18 evidence-based and cost-effective interventions. For 2022, the workgroup selected to focus on self-monitoring blood pressure (SMBP) by hypertensive patients with clinical support to improve health outcomes and reduce healthcare costs. Hypertension is the silent killer and is a comorbidity and risk factor for a number of other chronic conditions. One in 4 Utah adults have diagnosed hypertension and 15-30% of Utah adults have undiagnosed hypertension. Strong evidence supports that SMBP interventions, when combined with additional support like patient counseling, education, or web-based support, are effective in improving blood pressure outcomes in patients with high blood pressure. Home blood pressure monitors are a covered benefit under Utah Medicaid and many resources are available to support clinic training and member education to encourage accurate SMBP and clinical support.
10:00 a.m. “Beating Hypertension, the Silent Killer“ Dr. Richard Ferguson | Chief Medical Officer, Health Choice Utah
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The Utah 6|18 Workgroup is a cross-collaborative workgroup focusing on addressing 6 high-cost and preventable health conditions with 18 evidence-based and cost-effective interventions. For 2022, the workgroup selected to focus on self-monitoring blood pressure (SMBP) by hypertensive patients with clinical support to improve health outcomes and reduce healthcare costs. Hypertension is the silent killer and is a comorbidity and risk factor for a number of other chronic conditions. One in 4 Utah adults have diagnosed hypertension and 15-30% of Utah adults have undiagnosed hypertension. Strong evidence supports that SMBP interventions, when combined with additional support like patient counseling, education, or web-based support, are effective in improving blood pressure outcomes in patients with high blood pressure. Home blood pressure monitors are a covered benefit under Utah Medicaid and many resources are available to support clinic training and member education to encourage accurate SMBP and clinical support.
10:00 a.m. “Beating Hypertension, the Silent Killer“ Rachel Vasquez | Quality Program Manager, Health Choice Utah
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The Utah 6|18 Workgroup is a cross-collaborative workgroup focusing on addressing 6 high-cost and preventable health conditions with 18 evidence-based and cost-effective interventions. For 2022, the workgroup selected to focus on self-monitoring blood pressure (SMBP) by hypertensive patients with clinical support to improve health outcomes and reduce healthcare costs. Hypertension is the silent killer and is a comorbidity and risk factor for a number of other chronic conditions. One in 4 Utah adults have diagnosed hypertension and 15-30% of Utah adults have undiagnosed hypertension. Strong evidence supports that SMBP interventions, when combined with additional support like patient counseling, education, or web-based support, are effective in improving blood pressure outcomes in patients with high blood pressure. Home blood pressure monitors are a covered benefit under Utah Medicaid and many resources are available to support clinic training and member education to encourage accurate SMBP and clinical support.
11:00 a.m. “The Challenge is HOW not Why: Integrating the Social Determinants of Health in Healthcare“ Dr. Len Novilla | Associate Professor, BYU
1:00 p.m. “Countering Cybersecurity Risks Across Your Organization” Keith Roberts | Information Security Analyst, UHIN
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Presentation on the importance of cybersecurity in healthcare. We’ll look at a recent data breach investigations report, how to stop cybersecurity, and the importance of staff training.
2:00 p.m. “Decentralized Identity and Verifiable Credentials in Health Care“ George McEwan | Chief Strategy Officer (CSO), Department of Government Operations at the State of Utah
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On May 26th, 2011 Google introduced Google Wallet on android phones. Not to be left out of a really good marking term, Apple followed suit on September 19th 2012, launching Apple Wallet. Ten years later and it is still “novel” to pay with a phone. What happened and why does it matter now?
The future of legally binding, decentralized digital identity and verifiable credentials has expanded beyond simple digital wallets and is debuting in government in the near future. This session provides the background you’ll need to participate in the next identity revolution.
3:00 p.m. “Intro and Overview of the One Utah Health Collaborative“ James Wissler | Executive Director, One Utah Health Collaborative
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This intro/overview of the One Utah Health Collaborative will have an emphasis on the barriers and the importance of community alignment regarding interoperability. A panel of innovators, clinicians, and interoperability experts will join Jaime Wissler to discuss the questions of how and why we’re working toward a longitudinal health record.
10:00 a.m. “Motivating for Performance: How Leaders Can Help Teams Find Their Drive” Blake Bishop | Vice President of Data Services, Neovest, a JPMorgan Chase subsidiary
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Intrinsic motivation plays a pivotal role in organizational performance management. Not surprisingly, there is a strong correlation between employee motivation and business success. The factors that drive the desire to perform, however, may come as a surprise to many. In this presentation, we will explore what intrinsic motivation is, why intrinsic motivation matters, and how you as a leader can motivate your team members to perform at their peak.
11:00 a.m. “Medicare Hot Topics” Lori Weber | Provider Relations Specialist, Noridian Healthcare Solutions
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This presentation encompasses updates, important topics and valuable resources to assist your practice with successful Medicare billing.
1:00 p.m.“Life of a Claim: Creation, Rejection, Elation” Joy Cone | Application Support Analyst, UHIN
2:00 p.m.MYUHINClaims Greg Lobato | Group Product Manager, UHIN
3:00 p.m. Payer Panel Representatives from DMBA, EMI, HCU, Noridian Medicare B, PEHP, Regence, SelectHealth, and University of Utah Health Plans
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Q&A session with a panel of provider relations specialists and representatives from national and local, Utah health plans. This popular session answers some of providers most pressing questions. In previous years, questions have included:
Which are the most common errors that keep claims from processing?
What are the procedure codes with modifiers that should be used for phone visits for each insurance company?
Are all the payers reimbursing for Telehealth visits at the same rates as in person visits during the pandemic?
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Venue
Salt Lake Marriott Downtown at City Creek
75 S W Temple Street Salt Lake City, UT 84101
Free parking for 2022 HIT Conference attendees
REFUND POLICY
We will accept refund requests up to 10 days following the date of the conference. To be eligible for a refund, you must submit via email to events@uhin.org. In your email, include your name, order number, and number of tickets to be refunded, as well as a reason for the refund request.
Once we receive your request, we will review and notify you on the status of your refund. If your request is approved, we will initiate a refund to your credit card or original method of payment.
Please contact events@uhin.org with any additional questions.
77% of claims submitted identified providers as potential actor; only two claims identified HIEs
New ONC data shows almost 300 claims of healthcare organizations allegedly blocking access to patient data. Since information blocking regulations went into effect last April, the ONC has received 274 possible claims of information blocking.
Of those claims, 176 were submitted by patients. The majority of claims submitted (211) identified a “health care provider” as the potential actor, with 42 claims naming health information technology developers, and only two claims identifying health information exchanges.
Claim Counts by Types of Claimant
Claim Counts by Potential Actor
Source: Information Blocking Claims: By the Numbers – https://www.healthit.gov/data/quickstats/information-blocking-claims-numbers
“…the circumstances described in the claims may offer insight into potential impediments to EHI access, exchange, or use,” wrote ONC executives Rachel Nelson and Cassie Weaver in a release article. “Though we cannot tell through simple triage whether a particular claim represents information blocking as defined in the regulations, some of the concerns described in the claims we have received appear on their face consistent with examples of practices likely to interfere with access, exchange, or use of EHI that we described in ONC’s Cures Act proposed and final rules.”
In accordance with the 21st Century Cures Act, the ONC seeks to stop certain information blocking practices. New rules were issued in 2020 regarding information blocking regulations with compliance dates going into effect April 5, 2021.
UHIN has long been a proponent of interoperability across the healthcare industry. Our vision is to create a more connected healthcare system that drives innovation, collaboration, and inclusiveness.
The CHIE is an important source of data for Maliheh Free Clinic’s vulnerable patients.
The Maliheh Free Clinic’s patient population is a particularly vulnerable one.
Since Maliheh serves a demographic of patients that sit at up to 200% of the national poverty line, they don’t always have steady access to patient data or even contact information. Their patient population often has limited access to technology, and the clinic itself relies on access to Utah’s two major hospital systems’ EHRs. While this access covers some of their patients, Maliheh staff runs into challenges finding critical information on previous treatment: prescription information, lab results, and other data from other providers and facilities.
With only these tools, Maliheh’s process looks like this:
A new patient with medical data in another system must fill out a Medical Records Request form for each current or past provider. The form is mailed or faxed to each provider, and the patient is evaluated and treated to the best of the clinicians’ ability without previous medical history.
After that, well, the process is a little less clear-cut. Several possible barriers exist at this stage: the form needs to first reach the target provider, and they must actually send back the requested medical information. Sometimes, this requires Maliheh to send the request multiple times to try to get what they need. Once they have the information, staff must then track the patient down so they can provide care- and again, patients may not have steady contact information or addresses, and may have high difficulty in finding time to come back for another appointment. Ideally, Maliheh will provide as much care as possible to the patient on the first visit, but in cases such as these, it’s simply not possible.
Implementing The CHIE to tackle data gaps
In 2018, Maliheh heard about UHIN via an informaticist from one of the Utah health systems. With their small staff (only 12 contracted FTEs), it was going to be difficult to work on integrating a new program into their workflow, but UHIN’s Enrollment Team actively worked with clinic staff to make sure they could get some kind of access to the CHIE, UHIN’s Health Information Exchange tool. The clinic had no extra time to train up any tool experts on their own staff, but UHIN’s team was there for that as well, helping to resolve any usage or technical questions that arose.
Maliheh found that they suddenly had access to patient data and patient matching services for dozens of patients that would have been previously underserved.
As a result of implementing the CHIE as a supplemental data source, Maliheh found that they suddenly had access to patient data and patient matching services for dozens of patients that would have been previously underserved. When a patient’s missing data was in the CHIE, all of the time that their staff spend searching for documentation and trying to send communications could simply be spent providing care to their vulnerable populations. The CHIE was able to help Maliheh avoid long waits for paperwork, lost appointments, and missed care opportunities.
“It’s invaluable to us, it’s like Christmas when we find something in the CHIE. It’s really exciting.”
The CHIE was a solution for the information gaps in Maliheh’s EHR data and their patients’ knowledge of their own care history. With its help, Maliheh is able to provide care to hundreds more patients every year. “It’s invaluable to us,” said Nicole Mohr, Care Coordinator at the Maliheh Free Clinic. “It’s like Christmas when we find something in the CHIE. It’s really exciting.”
Summer is here and UHIN has already been cookin’ in 2021. We’ve made some big new CHIE connections, launched a new partnership with three other healthcare organizations, opened registration for the Provider Education Summit that is coming up in August, and much more. Read on to see what’s been happening this quarter!
News and updates:
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TestUtahLabs and Intermountain’s new Spanish Fork Hospital are now connected to the CHIE as primary data sources! TestUtah Labs are sending COVID-19 Lab Results to UHIN from the State, allowing us to alert providers when one of their patients has a new COVID test. The new Spanish Fork Hospital has been sending ADTs and CCDs since late April, adding to our ever-growing list of clinical data sources. Also, Dixie Regional Medical Center has changed its name to St. George Regional Hospital, which will be reflected in data connections. Learn more about Alerts here: CHIE Alerts
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UHIN Partners on New Joint Venture, BeyondHIE! UHIN has joined three other organizations poised to transform healthcare partnering to create a new company focused on helping health information exchanges (HIEs), payers and providers improve health outcomes. The four companies joining together are Comagine Health, Idaho Health Data Exchange (IHDE), Orion Health and the UHIN.
Read the full press release: Presser Visit the BeyondHIE website: Website
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Provider Education Summit 2021
Utah’s premiere event for billers, coders, and office managers is back
The Provider Education Summit (PES) is back!! And we’re doing an in-person format!! It’s time to network and learn with your billing and coding colleagues, so we are bringing the Payer Q&A Panel, guest speakers, and network of healthcare payers to all four Utah locations this August. Tickets are on sale now for each location. Price of admission covers:
Refer a friend for more chances to win prizes! Let your friends and colleagues know about PES 21 and tell them to mention your name at registration in the “How did you hear about the PES Event?” section. For every referral you’ll get an extra ticket for the raffles at the end of the event.
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Bi-Directional Exchange: Physician Fee Schedule Update – The CY 2021 Physician Fee Schedule Final Rule introduced the HIE Bi-Directional Exchange measure for MIPS. Financial incentives are available for providers who participate in an HIE that both sends and receives healthcare data for every patient encounter, transition or referral, and record stored or maintained in the provider’s EHR.
If you are a current CHIE customer, please contact us to learn how to get set up for bi-directional exchange reporting! If you are not a current CHIE customer, but you would like to qualify for the bi-directional exchange rule, call us at 877-693-3071 or send a message to chiesupport@uhin.org!
UHIN is working to make interoperability easier than ever. Our Healthcare Platform is being built for data-driven workflows, making healthcare analytics accessible and usable through a source-agnostic platform that will unlock the power of combining claims and clinical data. To get notified of Platform news, visit https://uhin.org/healthcare-platform/
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UHIN is Hiring!!
We have been adding new members to the UHIN Team like crazy and we still have open positions to fill! Check out our Careers page for updates: UHIN Careers
UHIN Soccer League
Stay up to date on everything happening here at UHIN by subscribing to the UHIN Newsletter and by following us on Twitter, Facebook and LinkedIN!
UHIN and Western Colorado’s Quality Health Network (QHN) are pleased to announce a more tightly linked connection between our health information exchanges which will improve patient outcomes, improve efficiencies, and help reduce costs in a shared coverage area throughout many parts of Colorado, Idaho, Montana, Nevada, Utah and Wyoming that includes more than a 100 hospitals and thousands of providers. The new real-time delivery of data between the two health information exchanges allows for clinical event data to be automatically delivered to the electronic health record (EHR) systems of providers who have a treating relationship with the patient and have subscribed to the services (Not subscribed? Contact our CHIE Team to get started!). The information will also be made available via query for authorized providers who may have a treating relationship with the patient in the future.
The ongoing patient data exchange between UHIN and QHN is initially triggered when a patient visits any of the Provider Participants of either QHN or UHIN. The health data delivered includes but is not limited to admission and discharge information, diagnostic laboratory and radiology results as well as care episode documentation from Emergency Room, Surgeries, as well as other Procedural Reports.
While both QHN and UHIN have been exchanging health data via query/response methods exchange since 2016, the stakeholders of both organizations have long hoped for the automated delivery of clinical data directly into providers’ health record systems. The new exchange modalities make this a reality and have been in production since May of 2021. The results of the exchange is already proving positive for both patients and providers.
Let’s Show You How It Works
Meet Travis. Travis lives in Grand Junction, CO. He has high blood pressure, coronary artery disease, is a bit overweight and a diabetic. He decided to exercise more and loves to bike, but he took a hard fall mountain biking in eastern Utah and was sent to Moab, UT for medical care. Before this data exchange enhancement, Travis’s Grand Junction doctors may not have known that Travis got hurt, much less where or how he might have been treated or what follow up care might be required to allow for Travis’s return to mountain biking. With this new exchange modality in place, Travis’ Moab doctor can query UHIN for information about Travis’ pre-existing conditions (including information from his Grand Junction primary care, cardiology, and endocrinology providers) and make better decisions about Travis’ immediate care needs.
Travis’ Grand Junction doctors are alerted that Travis’ had an accident and details of the care he received in Moab because that information is delivered automatically into the EHR’s of the Grand Junction doctors. Any follow up care Travis receives from the Grand Junction doctors is copied to the Moab doctor’s EHR for as long as the Moab doctor subscribes to Travis’ information. So both sets of physicians can collaborate on the care of Travis and get him back safely riding as soon as possible.
This is next-level patient centric care collaboration, is automatically triggered by patient care events, with data delivered directly into the EHR’s of treating providers. It means that Travis’s health information automatically follows him wherever he receives care for as long as his providers are subscribed to his information through either through QHN or UHIN. Even without subscription, Travis’ data is still available to treating providers via query/response data exchange between the two health information networks.
The two organizations have a long history of collaboration and this is just one of the many ways we continue to connect people for better health across Utah and the mountain West. We are Better Together.
Ready to get set up with the CHIE? Contact our team today to Get Started.
BOISE, Idaho — Four health care organizations are partnering to create a new company focused on helping health information exchanges (HIEs) and their communities, payers and providers improve health outcomes. The newly formed partnership, known as BeyondHIE, will offer a comprehensive suite of services, technology and project management to support value-based care.
BeyondHIE, a nonprofit organization, will support health care organizations by bringing together health data partners and enabling that data to be scaled and enhanced. The four companies joining together are Comagine Health, Idaho Health Data Exchange (IHDE), Orion Health and the Utah Health Information Network (UHIN). These industry leaders offer deep expertise in the areas of data quality, utilization, support and delivery. Together, they will provide services that support health care organizations on their journey to improve health care quality, while also assisting with funding of provider connectivity.
“Delivering improved outcomes using health information enables payers and providers to meet the health care needs of the community they serve,” said Brian Chin, chief executive officer at UHIN. “This joint venture can make vital health care data a reality for more communities.”
“We are excited to partner with these key industry leaders striving to improve health outcomes throughout the U.S.,”said Ian McCrae, founder and chief executive officer of Orion Health. “This joint venture will support improvements in population health by making data accessible when and where it can make a difference.”
“This partnership allows us to offer analytic expertise in support of improvement and decision making,” Marc Bennett, Comagine Health’s president and chief executive officer, said. “The potential impact to improve health and create a better health care system is exciting.”
“This partnership supports health systems by bringing together health data partners allowing data to be scaled and enhanced across broad geographies,” Hans Kastensmith, IHDE’s executive director, said.
For more information about BeyondHIE visit: beyondhie.org.
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About BeyondHIE
BeyondHIE delivers improved outcomes using enhanced secure health care information, enabling payers and providers to meet their patients’ health care needs with the full range of support ensuring outperformance on value-based reporting requirements. BeyondHIE delivers population level aggregated data at the right place and time. BeyondHIE makes consumer health information available when and where you need it; safe, informative, in your clinician’s hands. For more information, please visit beyondhie.org.
About Comagine Health
Comagine Health, formerly Qualis Health and HealthInsight, works collaboratively with patients, providers, payers and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system. As a trusted, neutral party, we work in our communities to address key, complex health and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics and research. We invite our partners and communities to work with us to improvehealth and redesign the health care delivery system. For more information, please visit comagine.org.
About Idaho Health Data Exchange
Idaho Health Data Exchange (IHDE), a non-profit 501(c)(3) company, is Idaho’s statewide Health Information Exchange, dedicated to meeting the needs of healthcare providers and ensuring that Idaho’s citizens receive the most effective health services possible. To achieve these goals, IHDE is working with a wide-array of stakeholders and actively building a best in breed technology infrastructure to provide access to reliable data and information, combining traditional healthcare data with other data sources to help address the medical, behavioral, and social needs that influence the well-being of Idahoans. For more information, visit https://idahohde.org/.
About UHIN
UHIN is a non-profit 501(c)(3) organization dedicated to creating a more connected healthcare system. At our core, we enable organizations to interoperate with disparate health systems easily and securely, EHRs, PMs and other IT systems. By driving the adoption of innovative technologies and promoting a community of collaboration and inclusiveness, we are bringing together healthcare providers, hospitals, health plans, ACOs, government organizations and more to share vital information critical to their success. Learn more at www.uhin.org.
About Orion Health
Orion Health is a global, award-winning provider of health information technology, advancing population health and precision medicine solutions for the delivery of care across the entire health ecosystem. Orion Health provides a state-of the art multi-tenanted HIE platform, which has been subscribed to by 4 statewide Health Information Organizations, to support a suite of solutions to enable clinicians to extract meaningful insights and make more accurate decisions about patient care, delivering patient-centered healthcare and quality health outcomes that help patients live a healthier life. Our technology is used by hundreds of thousands of clinicians across the globe to manage the health care of more than 100 million patients. We specialize in open technology systems that seamlessly integrate all forms of health and personal data across the entire health community and present that data back to users in real time to provide optimum patient care. We believe that software needs to do more than serve up data; it needs to provide insights in real time to the people who need it, when they need it. For more information, please
A full quarter is in the rear-view mirror now, and it’s already been a fun 2021. UHINt was given its proper send off, MYUHIN is getting rave reviews, The Annual Forum is almost here again, we set up new CHIE connections, and much more.
The biggest news and updates so far:
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MYUHIN in the spotlight! It’s been a big quarter for our web-based electronic billing platform. Customers love the user-centric design and functionality, and they love our customer success and support teams! The price is set for providers offices who need an exceptional billing tool without wrecking their revenue…
UHINt officially retired – After 20 years we have given UHIN’s original hand-entry claims tool, UHINt, its final ride. All users have been moved over to the new and improved MYUHIN.
Self sign-up & Enrollment appointments – User can now sign up for MYUHIN themselves! For those who need enrollment help, however, will need to work with our Enrollment Team. If you are looking to Enroll with your target payers, user our Calendly scheduler: Schedule with Enrollment Team!
The 2021 Annual Forum is coming and we’ll be officially announcing our Keynote speakers in the next couple of weeks!
This year topics will focus on changes in the Payer landscape and how they affect all players in healthcare, especially as it relates to interoperability. Stay tuned for announcements on our event page here: UHIN Annual Forum
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CHIE Updates – Since our last update we continue to add new features and data sources to enhance our HIE. Some of the more important updates:
DIRECT update – You can now download a .CSV of ADTs directly from the MYUHIN portal
New Data Sources
Wyoming Frontier Information (WYFI) – ADTs (Dec 2020)
Rocky Mountain Homecare and Hospice – CCDs (Nov 2020)
Bonneville Family Practice – ADT and TRN (transcriptions/progress notes) (Nov 2020)
Chesapeake Regional Information System (CRISP) the HIE for Maryland and DC (Nov 2020)
Highland Care Center – ADTs (Nov 2020)
Pointe Meadow Health and Rehabilitation – ADTs (Nov 2020)
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Security & Compliance Updates
SOC 2 Type II
FedRamp Compliant
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UHIN is Hiring!!
We have been adding new members to the UHIN Team like crazy and we still have open positions to fill! Check out our Careers page for updates: UHIN Careers
UHIN Soccer League
Stay up to date on everything happening here at UHIN by subscribing to the UHIN Newsletter and by following us on Twitter, Facebook and LinkedIN!
