Payer Solutions

UHIN is a non-profit clearinghouse with over 20 years’ experience exchanging data for electronic medical billing. UHIN also operates a community-based health information exchange (HIE), supporting continuity of care, lower costs, and better outcomes. We offer a wide variety of clinical and clearinghouse services, including products that unite disparate data to help our partners make better decisions.

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UTRANSEND Clearinghouse Services

UTRANSEND, UHIN’s clearinghouse, provides services that reduce your administrative costs. It is a comprehensive electronic solution for all aspects of the billing and reimbursement process, from increasing your clean claims rate to sending out remittance advice.

  • Maintain billing cycle efficiency with all-electronic:
    • claims
    • eligibility
    • claim status
    • enrollment
    • remittance advice.
  • Connect to providers using a system compliant with CORE operating rules.
  • Exchange data via SFTP, web services or CORE connectivity processes.
  • Identify edits that can reduce common claim errors and unprocessed files.
  • Recognize patterns in claim rejection reasons and target provider outreach efforts.
Clinical Health Information Exchange (cHIE)

The cHIE is a secure electronic network that supports faster, safer, and more clear communication about important medical information. Payers can use the cHIE to find the information needed for effective case and disease management. By reducing the burden of requesting records multiple times via phone, mail or fax, the cHIE enables secure, fast electronic record exchange, freeing staff to focus their efforts where they’re needed most.

Clinical Portal

Through the Clinical Portal, payers can access community-sourced clinical data to coordinate care for members who are receiving case management services. Available data includes problems, allergies, medications, immunizations, procedures, care plans, and discharge summaries, displayed in a customizable patient-centric view. Data is contributed by hospitals, clinics, laboratories, and long-term care facilities throughout Utah and surrounding states.

cHIE Alerts

The cHIE Alerts system sends you secure notifications when your members are admitted to or discharged from a hospital or emergency department. These Alerts enable case managers to coordinate with both inpatient and outpatient providers before members are discharged, for seamless hospital-to-home transitions. Coordinated care lessens the members’ risk of readmission or complications.

 

You can receive cHIE Alerts in real time or choose custom delivery times. Alerts are delivered via cHIE Direct secure email or SFTP.

cHIE Direct

cHIE Direct is an encrypted email system supporting large files in multiple formats. cHIE Direct accelerates the billing cycle by allowing payers to receive and automatically process claim attachments, and request additional documentation within the same system.

cHIE Direct is based on nationally-accepted standards, and can send up to 40 MB of files per message in formats including Word document, PDF, JPEG, and TIF.

CareAchieve

CareAchieve, UHIN’s analytics tool, makes population health possible for payers of all sizes. CareAchieve gives case managers the ability to create customized dashboards and graphs of member cohorts. These tools identify at-risk members to allow proactive intervention, track the prevalence and severity of a health condition among each cohort, and highlight patterns in a condition’s development within a particular demographic group.