Provider Credentialing and Provider Enrollment: What’s the Difference and Why Does it Matter?

Patient at doctor's office reception desk with nurse

Provider enrollment is crucial for health plans to ensure that members have access to a full range of services. Credentialing verifies a clinician’s training and licensing. Enrollment establishes the technical connection between the provider and the plan. The processes can be complex and time-consuming, but partnering with dedicated enrollment experts – like UHIN – can help streamline the onboarding experience and accelerate success in a highly competitive marketplace.

Why Enrollment Matters

Health plans are constantly looking for better ways to serve the insured, from developing innovative wellness benefits to making it easier to access high-quality, affordable care in the community.

Provider network development is a huge component of this quest for continuous improvement.  Contracting with the right mix of providers – and enough of them – ensures that members can get a full range of services within an acceptable time frame.

Building this ecosystem isn’t always easy, especially when it comes to the nuts and bolts of bringing clinicians on board. Provider credentialing and provider enrollment are equally critical, yet they can often cause confusion and problems on both sides of the plan-provider relationship. 

In fact, providers not being registered/credentialed with a payer is the #1 reason for denials. The #2 reason for denials: the provider did not complete the payer-required process for enrollment.

Both steps – credentialing and enrollment – are crucial. However, even the fundamental differences between the two activities aren’t always clear, especially because they bump up against each other during onboarding. It’s important to understand what’s involved in each process, how they work, and why finding the right partner matters so much to health plans as they grow and mature.

What is Provider Credentialing?

Provider credentialing is the act of verifying that a clinician has the correct training and licensing to practice in their area of expertise. It’s similar to an extensive background check. The process starts after a provider submits a request to work with a practice, health system, or health plan. Collecting this extensive dataset can take up to three months or longer. 

While UHIN does not currently support the credentialing process, certain industry applications are in place, including the CAQH credentialing application. Until the credentialing process is complete, a provider cannot finish the rest of the enrollment process with a health plan. This is especially important for 98 percent of providers in the US who participate in Medicare and Medicare Advantage. In addition, nearly every health plan, including Medicare, requires EDI enrollment in order to start getting reimbursed for services.

What is Provider Enrollment?

Once a provider is officially welcomed into the network, the majority of health plans will require them to complete Electronic Data Interchange (EDI) enrollment, which is the technical connection between the provider and the plan. EDI enrollment allows providers to submit electronic claims to the plan and receive remittance for their services.

Electronic claims submission is nearly universal in the medical industry, according to the latest CAQH index report. In 2022, 97 percent of claims submissions transactions occurred electronically, giving both providers and health plans a strong motivation to ensure they are appropriately connected.

Unfortunately, neither the administrative nor the EDI enrollment processes are standardized across different health plans. This forces providers to juggle many different requirements and documentation requests for each individual payer. The complexity of managing requests from a slew of disparate plans and providers can lead to mistakes and omissions that extend the timeline. 

Even more information may be required during EDI enrollment than credentialing. This can take an additional four to six weeks (or longer) on top of the credentialing timeframe. This is especially true if extensive contract negotiations are necessary or IT challenges get in the way.

In addition, smaller provider groups often do not have enough people-power to devote exclusively to enrollment, making it even more difficult for plans and providers to work together effectively.   

UHIN’s Enrollment Team provides detailed next steps for enrollment based on each specific payer and transaction type for each case. Additionally, we provide defined next steps to move forward with enrollment, based on the payer requirements. UHIN can be reached at and we will be happy to provide enrollment direction, advice and helpful support through the EDI enrollment process.

How Can Health Plans Streamline Enrollment Processes?

Just like many other areas of the healthcare ecosystem, provider EDI enrollment can significantly benefit from digitization and strong partnerships with expert teams. The widespread lack of standardized processes means plans and providers have to consider each request as a one-off, which can take a great deal of time and effort to parse through without some help.

Charting a Course for Success

When working with providers, health plans should offer clear and detailed instructions on the information needed and the deadlines for delivering it.

Plans should assess their needs by charting out their existing enrollment workflow and identifying any bottlenecks that lead to lag time. Often, these pain points are related to delays in collecting information from providers and internal delays in processing paperwork once received. The result of these delays are wild swings in average completion time for provider onboarding, which creates unpredictability on both sides of the relationship. 

Finding the Right Support

On the internal front, plans should seek out enrollment partners that can field provider requests on behalf of the payer, taking the task off the shoulders of health plan staff. It should take a specialist enrollment team less than one business day to process a request once all of the information is received. There may be additional waiting time depending on the unique payer requirements.

Health plans and providers should make sure they are working with a dedicated enrollment team that can take deep dives into problem-solving when unique technical or administrative challenges arise, such as a technology enhancement that can lead to the need for a process rewrite.

An experienced partner, such as UHIN, offers an expert enrollment team to help navigate the complicated enrollment process. Although we do not currently provide credentialing support, we have a proven history in expediting and accurately guiding providers through the enrollment process. Our enrollment team is based in the US and delivers in-depth knowledge and support to make the enrollment process as frictionless as possible. We can handle any questions you may have in this complicated and critical process.

Partnering with the Right EDI Enrollment Experts

Enrollment involves complex activities with many moving pieces. Getting them right is vital for the success of health plans and provider groups. By understanding the nuances of the process, plans and providers can start to tackle the pinch points that make network development so challenging. Plans that enlist the help of dedicated partners to take on key tasks, such as enrollment, have a better chance of creating a smoother onboarding experience and accelerating their success in a highly competitive marketplace.

UHIN’s enrollment team offers years of experience helping providers through the enrollment process. We provide direct support and in-depth knowledge to expedite the enrollment process and get providers over the finish line no matter how complex or unique the process may be.

Are you a current provider with a UHIN account and interested in learning more about enrollment? Contact or customer service at 877-693-3071.

If you’re new to UHIN, click below and tell us how we can help streamline EDI enrollment onboarding and relieve burdens for your health plan!

How Electronic Administrative Transactions Are Decreasing Costs and Administrative Burdens For Health Plans

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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 standards for 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.

Why Clearinghouses are Underrated as Key Enablers of Healthcare Interoperability

Two people walking in hallway

Clearinghouses are more than just utilities for moving claims from provider to payer. They are integral to improved healthcare interoperability and the quest to extract valuable insights from clinical and administrative data.

How Clearinghouses Help to Enable Interoperability

When talking about interoperability in healthcare, clearinghouses aren’t always the first thing that comes to mind. For many years, the conversation has been much more focused on the exchange of purely clinical data from one provider to another – a challenge that is still only partially solved even after decades of hard work.

While clinical data exchange is certainly vital to success for patients, health plans, and providers, it’s just the tip of the interoperability iceberg. Accurate claims data is equally important for making informed, proactive decisions about patient care.  

Claims data doesn’t just offer deep insights into everything from overall provider performance patterns and to an individual’s ability to engage with their care plan. It’s also essential for the day-to-day business of being a payer: reimbursing providers for the wide variety of services aimed at improving member health.

Clearinghouses are the technology that makes this all possible. By coordinating the secure flow of claims information between providers and health plans, clearinghouses quietly and steadily keep the $4.3 trillion healthcare industry humming along.

It’s easy to look past this type of “middleware” solution, especially when it works well enough to avoid causing any major issues. But skipping over clearinghouses during the interoperability discussion would be a mistake, especially as payers and providers start to engage with increasingly complex, unstandardized data sets and new types of clinical and financial partners in a more patient-centered, value-based environment.

It’s time to take a closer look at the clearinghouse as a fundamental enabler of trusted interoperability between trading partners and ensure that both payers and providers are maximizing the value of what these important platforms can do.

The Crucial Role of Clearinghouses in Healthcare Operations

Every year, healthcare providers submit hundreds of millions of claims for patient services to thousands of health plans across the nation.

Just building the electronic pipelines to shuffle all this data back and forth each day is a monumental task. Making sure that the information is accepted and processed in a standardized manner, correctly integrated into a health plan’s internal reimbursement systems, and returned to the provider in a timely manner with the right payment – or a clear explanation for denial – is even more challenging. 

Clearinghouses work in conjunction with electronic billing software to handle these processes digitally, proactively identifying common data integrity issues that may result in a denial or delay. Once a provider generates a claim using the standard 837 claim format, the clearinghouse accepts the file, scours it for any obvious errors, and sends it on to the correct health plan if it passes all the checks.  

The plan then conducts further analysis for clinical and administrative suitability of the claim and makes a decision on whether to reimburse as requested, deny outright, or ask for clarification.

The more sophisticated and trustworthy the clearinghouse, the less work has to be done on each side of the partnership. Robust clearinghouses with more automation, advanced analytics capabilities, and a trusted position within the health IT community are associated with lower overall denial rates and higher first-pass success rates, which is good for providers, as well as reduced administrative burdens on the payer side.  

The American Medical Association estimates that electronic clearinghouses can reduce the cost of claims processing by approximately 60 percent compared to similar paper-based workflows, freeing up time and capital to devote to other clinical or operational priorities.

According to CAQH, transitioning to fully electronic transactions could save the industry up to $25 billion per year, or 41 percent of annual spend in 2022.

Using Clearinghouses to Create a Network of Networks for Better Claims Data Exchange

A single clearinghouse cannot work in isolation, because health plans don’t just receive claims from their established, contracted in-network providers. They also get claims from an untold number of out of network clinicians from anywhere in the country.  

This can be challenging on several levels. First, reimbursement rates and requirements are different for these partners. Second, out-of-network providers may not be familiar with the correct formatting and data requirements necessary to get their claims adjudicated quickly. And third, without being directly connected to the prospective payer’s proprietary clearinghouse, these providers must simply trust that hitting “send” on their claim form will result in getting that information where it needs to go.

This is where the right clearinghouse solution can take interoperability to the next level. Clearinghouse vendors must work with their peers, trading partners, and competitors to ensure that all claims, no matter their origin, are routed to the appropriate recipient with as few gaps and errors as possible.

Data standards like ASC X12 Version 5010 make it possible for clearinghouses to assemble into “networks of networks” and make certain that any provider can reach any payer whenever necessary.

Fortunately, the ASC X12 standard is well established in the electronic data exchange community, and claims are typically highly structured documents with relatively few unknowns, making it easier for clearinghouses to engage in the type of interoperability that is often so elusive in the clinical data ecosystem.

Trust as the Bedrock of Interoperability Between Payers and Providers

With trillions of dollars and huge volumes of sensitive clinical data shooting across the claims superhighways at any given moment, it’s essential that all parties involved have full and complete trust in their clearinghouses.

Choosing a clearinghouse with a strong reputation for security, service, experience, and responsiveness can turn an oft-overlooked piece of the interoperability puzzle into a valuable and proactive partner for improving clinical care and administrative efficiency.

A prospective clearinghouse solution provider should be able to demonstrate its mature and wide-reaching connections with peers across the industry to foster seamless interoperability for both in- and out-of-network claims. Platforms should also include process enhancements such as tools to generate cleaner claims, timely provider notifications at key steps in the process, and helpful resources to address any provider questions or problems that arise before or during claims submission.

With a trusted and collaborative clearinghouse, health plans and providers can work together more efficiently and effectively to accomplish their daily tasks while moving into the optimal position to take advantage of everything that rich, robust claims data has to offer. 

Clearinghouses shouldn’t just feel like part of the furniture. Instead, they should become an active and integrated part of a health plan’s larger interoperability goals. By simplifying and streamlining the claims submission process, clearinghouses don’t just save time and money for payers. They can also unlock the full potential of claims data for broader financial and clinical analytics purposes, such as provider performance monitoring, population health management, and other high-priority value-based care activities.

Grow Your Business in 2023 with Two Simple MYUHIN Tools: Templates and Drafts

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Are you really, truly ready to grow in 2023? Using MYUHIN Templates and Drafts could help your clinic or private practice save time, ease administrative burden, improve cash flow and grow now.

Templates Put You Closer to the Finish Line

Providers spend as much as 10 minutes submitting one electronic claim – and 22 minutes for paper! (2022 CAQH Index) Seemingly small, ongoing hurdles, like repetitive data entry, can impede your growth. Save time in 2023 by creating claim Templates that you know will work! Create one claim, one time, then use it over and over again. Why start from scratch when you can start only a few clicks away from the submission finish line?

Submit your claims even faster and stay on top of your practice’s billing by leveraging our lightning-fast submission process. If you’re working long hours to get your work done in a timely manner, you can reclaim your time, finish work faster and decrease stress. We’ll keep you informed as your claim makes its way from submission to payment.

You can set up your template for your unique circumstances. Everything in the claim form can be configured, except for:

  • Patient Name
  • Date of Service

Take Control with Drafts

Ever been distracted and have to get up from your claim mid-submittal? How many times have you been close to completing a claim only to find that you still need key information to complete it? MYUHIN’s Drafts tool to the rescue!

Using our Drafts tool, you can start your claim, save your progress (Drafts), step away, then come right back to where you were in your workflow. It’s easy to save your progress with the Drafts tool: Just click save as Draft, then pick up where you left off without losing any of your existing work. No more sticky notes or notepad scribbles! 

Clinics, private practices, and billers use MYUHIN everyday to check eligibility and submit claims to our national network of payers. You can access MYUHIN from any PC or Mac connected to the internet (no software installation necessary). MYUHIN is an intuitive tool that enables anyone, so you won’t need hours and hours of training to get the job done. Everything just falls into place for you.

We hope you’re ready, because everyone is counting on YOU!

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By Greg Lobato, Group Product Manager, UHIN


2022 HIT Conference

Presentations from the 2022 HIT Conference

Provider Education Track Presentations

Interoperability Track Presentations

Healthcare Landscape Track Presentations

Data and Care Delivery Track Presentations

About the Conference

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.


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.

1:00 p.m. “Health Equity: Stop Talking, Start Doing”

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

Sara Hallvik

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 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. MYUHIN Claims
Greg Lobato | Group Product Manager, UHIN

Payer Panel

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?






Salt Lake Marriott Downtown at City Creek

75 S W Temple Street
Salt Lake City, UT 84101

Free parking for 2022 HIT Conference attendees


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 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 with any additional questions.

ONC Releases Data on Information Blocking Claims

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 –

“…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.”

Claims of potential data blocking were received through the Report Information Blocking Portal and the ONC plans to release updated data each month on a dedicated Information Blocking web page.

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.

Supplementing Patient Data for Maliheh Free Clinic

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.”

Clinical Health Information Exchange
To learn more about how CHIE data can help your organization, visit our CHIE page at

Does your organization need access to CHIE data and solutions? Contact us here

To learn more about Maliheh Free Clinic and their mission, visit

You can also download the Success Story One-Pager here:

We’ve Got You Covered in the Mountain West: New Link Between QHN and UHIN!

New Connections and Better Coverage

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.


UHIN Partners on New Joint Venture, BeyondHIE

UHIN will Join Three other Health Care Organizations Poised to Transform Health Care

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:

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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

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

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

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

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