Newsletter: May 2024 Issue

MAY 2024

For many of us, Memorial Day marks the unofficial start to summer. Hard to believe we’re heading into June! In this month’s newsletter, we look at the importance of resilient, redundant and interoperable systems, the events and webinars coming up, and we attempt to foretell everything that will happen for the rest of the year.

Remember to join us on LinkedIn for frequent news and updates!


The first half of this year was packed with exciting news and rocked by tech incidents. While we can’t predict the future, we can plan a better path ahead

Look into your crystal ball 🔮 What are your predictions (big or small) for things to come in healthcare this year? And, what are your goals that you hope to accomplish? We want to hear from you! 


John Lynn and Colin Hung look at where the industry stands just two months following the ransomware attack. For healthcare professionals, this could be a watershed moment for information security, revenue cycle management (RCM) and back-up planning for potential, future incidents.


City connected with blue lines of communication

Our most recent blog post (authored by Brian Chin, UHIN’s CEO) addresses the importance of redundant and resilient healthcare systems, and how they support seamless interoperability in times of crisis. There are, of course, great benefits and challenges when it comes to maintaining interoperability during disaster recovery (see them below👇).


September 13: Utah Medical Association (UMA) annual House of Delegates in Midvale, UT

October 15-17: Civitas Annual Conference in Detroit, MI

​​​​More to come: Stay tuned!


people icons

We’ll host training sessions on the new CHIE platform, specifically for portal users. Stay tuned for more details on our virtual Payer Panels where you can ask questions and get answers from health plan representatives.


May is Mental Health Month. Our partners and customers offer services and solutions that can help, including AARP Utah’s mental health and wellness resources and Valley Behavioral Health’s treatment programs and services for children and youth. We invite you to learn how you can get involved all year by visiting Mental Health America.



Newsletter: April 2024 Issue

APRIL 2024

This month we announced our affiliation with Comagine Health and added new CHIE data sources from CommonSpirit Health. We look forward to growing with our new strategic partners, customers, and you! Keep reading for what else happened in April and what’s coming up next month.​​​​​​

P.S. Follow our LinkedIn page for more frequent news, posts and insights


“Aligning our health care knowledge and expertise through affiliation is a profound opportunity to advance our parallel missions, while delivering greater success to our customers and partners. We have collaborated successfully for more than a decade. As affiliates, UHIN and Comagine Health can serve as a unified force for change in health care for the foreseeable future.”

​​​​​​- Brian Chin, UHIN’s Chief Executive Officer

Keep scrolling for more information on our affiliation.


Comagine logo, UHIN logo, Comagine and UHIN affiliation announcement

We have announced our official affiliation with Comagine Health, a national nonprofit healthcare consulting firm. We have a long history of working together over the last decade on federal and state initiatives to advance electronic health record (EHR) adoption, cost transparency reporting, capacity and functionality of all-payer claims databases (APCDs) and interoperability and surveillance activities. Combining our technology solutions and Comagine Health’s analytic services will enable more actionable health insights and more sustainable, transformational improvements for communities.​​​​​​


CommonSpirit health logo, UHIN logo, New data source CommonSpirit Health

The CHIE continues to add important data sources, providing healthcare professionals with vital medical information when it is needed most. Recently, we’ve onboarded CommonSpirit Health as a data source.


WEDI spring conference

We’re attending the WEDI Spring Conference from May 13 – 16 (virtually). We look forward to learning more from experts, like Aneesh Chopra, about solutions to improve information exchange, enhance care quality, and reduce cost and burden. 

Are you planning to attend online, too?


In addition to online product trainings for our customers, we’re preparing virtual payer panels for later this year. These will be similar to the payer panels you may have attended in previous years at the HIT Conference.


We’re reading the recent CAQH report on the wide differences in administrative transaction costs for generalists, specialists and behavioral health providers. “The medical industry spends an astonishing $83 billion annually on staff time to conduct routine administrative transactions between providers and health plans during and after a patient-provider encounter. Providers shoulder 97 percent of these costs.”



Newsletter: March 2024 Issue

MARCH 2024

“Our life is March weather, savage and serene in one hour” (Ralph Waldo Emerson)

Such was life in the healthcare information technology sector this month. We collectively faced daunting cyber circumstances and peered into an optimistic future filled with the possibilities of A.I., resilient and redundant networks, and healthcare interoperability for all.


Cyberattacks affect all of us. We're here to help.

UHIN is dedicated to maintaining interoperability for all payers, providers and partners. When an event as large as the Change Healthcare cyber incident impacts our community, we know we need to serve as a bridge to stable ground. Read more about the actions we’re taking to support our community at this time.


We’re actively supporting Providers by expediting enrollment with Payers to get claims flowing again. Providers can leverage our solutions to create and send professional and institutional claims, submit via SFTP, file tool or online hand-entry, check claims status, manage denials and rejections, and search, view, and download payment information.

We can connect with health plans, so they may receive claims from providers through a direct connection to our clearinghouse. Empower your provider network by elevating your collaboration efforts, securely sharing information and data, and providing better affordable care for your members.​​​​​​


Typing on computers

The alarming rise in cyber threats – namely ransomware – highlight the urgent need for enhanced cyber resiliency and robust security measures in healthcare. Read our recent blog post with five ways to reduce your risk and secure personal health information (PHI) from cyberattacks.


HIMSS shared their recap of the 2024 Global Health Conference & Exhibition (March 11-15 in Orlando). Cybersecurity, A.I.,and health equity and access to care delivery were big themes this year. What were you most excited to learn at HIMSS this year?


We’re preparing a series of online trainings for CHIE users this year. Explore our new platform and share feedback with our HIT experts. Stay tuned for updates on upcoming trainings.


Comagine Health logo

Comagine Health President and CEO Marc Bennett addresses how the organization has been managing competing tensions while building partnerships to serve as a prime contractor for the 13th Statement of Work in the Midwest CMS QIN-QIO Region 6.



Newsletter: February 2024 Issue

February 2024 Newsletter

February 2024

Thanks for spending this extra day going around the sun with us. In February, we dove into the 2023 CAQH Index Report and prepared for the CHIE’s migration to a new platform.

One more thing: For our providers experiencing disruptions in their claims management due to the Change cyberattack, we’re here to help. Please contact us to fast track your enrollment with payers at customersuccess@uhin.org.


American Heart Month

In February we recognized Black History Month and American Heart Month. Here are just a couple ways to support and celebrate these causes throughout the entire year:

For health care professionals and clinicians, use the resources in the Center for Disease Control (CDC) heart toolkit to support their patients, especially women, by listening to their heart.

In Utah? Dive into Utah’s rich black history at the Utah Black History Museum! Find the mobile exhibit across Utah this year or consider donating.​


CHIE platform

The new platform empowers CHIE users to better understand patient populations, provide greater care, reduce waste while improving quality, and pinpoint at-risk patients to intervene before their next encounter.

After consulting with our community’s advisory committee, we will be migrating five years of data with the exception of opt out consents, immunizations, allergies, and colonoscopies for which a longer history will be migrated.

Technical implementation is currently underway and we anticipate user migrations will start in Q2 of 2024. We will keep all CHIE users informed of our progress via email.


Copyright CAQH

We published two blog posts sharing our thoughts on the most recent CAQH Index released earlier this month. How did electronic transaction adoption and healthcare administration change in 2023 for both providers and payers? Keep reading to find out.


Our CEO, Brian Chin, recently attended ViVe 2024. Artificial Intelligence was a hot topic this year, as you may have expected. Check out a few photos from the conference here.

Are you going to HIMSS 2024? Let us know what you’re most excited to see while in Orlando next month at communications@uhin.org.


We have online trainings coming up for the new CHIE platform. Please sign up for CHIE updates and our Events notifications to add these to your calendar so you don’t miss a thing!


Do you have something your peers in healthcare and tech just have to know about? An innovative interoperability solution or point of view? Please email us at communications@uhin.org and we’ll include links to our favorite community content each month.

Next month we’ll attend HIMSS 2024 and help to raise awareness of the risks and symptoms of diabetes on American Diabetes Alert Day (March 26). 


2023 CAQH Index Report: Insights for Healthcare Providers

The Council for Affordable Quality Healthcare (CAQH) released their annual index report earlier this month. Data from the 2023 CAQH index sheds light on electronic administrative transaction adoption rates, areas of waste and cost avoidance, and the impacts of medical staffing shortages. At UHIN, we’ve recognized similar, significant trends through our claims management, specifically in claims submission, claims status inquiry and electronic remittance advice (ERA).

Here are our points of view and takeaways from the 2023 report:

  1. Staffing shortages are a major issue
  2. Electronic adoption increased
  3. Cost and Time spent increased
  4. Collaboration & flexibility are critical
  5. Transaction findings:
    • Claims submission
    • Claims status
    • Eligibility and Benefits
    • ERA

1. Staffing shortages are a major issue

The COVID-19 pandemic strained the healthcare system, which led to significant staffing shortages that continue to impact the industry, especially for providers. The impact of the pandemic is felt most intensely in the time to conduct administrative tasks: 

  • Provider time to conduct transactions increased in 2023, on average, 14 percent which accounted for 77 percent of the increase in total medical spend.
  • For the second consecutive year, time to complete electronic transactions grew. While staffing issues and transaction volumes increased, providers required more time to commit administrative tasks. 

Staffing issues were felt in the hiring process as less experienced staff were onboarded who ”required more time to understand processes and requirements.”

Our MYUHIN billing and claim management solution helps ease the onboarding burden.  An intuitive platform like MYUHIN won’t require hours of training to get the job done. New staff can get started quicker and manage your revenue and cash flow better from the start. Tools like Templates and Drafts reduce the time to submit claims. Everything will just fall into place for you.

2. Adoption increased:

In the “new normal” – as CAQH defines this era – adoption of electronic administrative workflows continued to rise in 2023 on the heels of new processes put in place during the pandemic. Per CAQH: “Automated tasks provided flexibility to staff as work environments changed and adapted to a new normal.” These transactions saw the greatest electronic adoption rate:

  • Remittance advice increased from 83% to 88%
  • Eligibility and benefit verification increased from 90% to 94%
  • Electronic claim status inquiries increased from 72% to 74%
  • Claim submission increased from 97% to 98% (almost reaching full adoption)

We noticed a rise in electronic claims submission this year, as well. MYUHIN delivered its one millionth claim in tandem with the uptick in submission volume. We empower you to accelerate your claim submissions, check coverage and benefits of patients in real time, and facilitate status inquiries from payers. These are all critical components to your revenue and cash flow management. 

3. Cost and Time spent increased:

Per CAQH: “Despite the increase in electronic transactions and decrease in manual ones, overall spending on administrative tasks grew due to persistent staffing challenges impacting the time to conduct tasks.”

  • Provider time to conduct transactions increased 14% (on average), the second year that the time to complete electronic transactions has grown.
  • The amount of time for a provider to submit a claim can take up to 20 minutes for a paper claim and up to 10 minutes for an electronic claim.
  • Spending on claim submissions rose 67 percent to $19 billion 
  • Medical providers reported spending, on average, 24 minutes on manual claim status inquiry, costing approximately $12 per transaction – the highest time and cost among the transactions along with prior authorization.

For providers, you can save time by checking eligibility and submitting claims with MYUHIN. If you want to reduce costs (who doesn’t??), our value pricing makes your decision to switch billing solutions a snap.

“With the data and technologies available to us today, we have the power to transform the way we conduct the business of healthcare. However, as an industry, we must align around consistent processes that enable providers to minimize the time spent learning new workflows. This is particularly important given the current labor shortage.”

Erin Weber, Chief Policy and Research Officer at CAQH (via CAQH)

4. Collaboration and flexibility:

Looking ahead, the CAQH index report notes: “As staffing concerns are expected to continue, the industry needs to work together to identify solutions and best practices for time savings.” Claim submission data was particularly dysfunctional between providers and payers, driving an increase in claim denials in 2023. We all need to work together to address the challenges in the medical industry.

We believe in interoperability for all. Healthcare is complex and challenging. Healthcare silos are ingrained in the industry. Where fragmentation begins, quality of care decreases and costs rise. When UHIN looks at the fragmented nature of healthcare we know we need to act and be a force for change.

5. Let’s dig into the transaction analysis:

Claim submission:

  • $2.1 Billion in cost savings opportunity annually for electronic claim submission 
  • 5 minutes in time savings opportunity per transaction for electronic claim submission for providers

Claims status inquiry:

  • The number of claim status inquiries conducted increased by 19%
  • 17 minutes in estimated time savings opportunity per transaction
  • Medical providers reported spending, on average, 24 minutes conducting a manual claim status inquiry, costing approximately $12 per transaction – the highest time and cost among the transactions along with prior authorization
  • $3.2 Billion in cost savings opportunity annually for the medical industry

Eligibility and benefits:

  • Adoption of the electronic eligibility and benefit verification transaction increased 4 percentage points for the medical industry, one of the largest increases
  • Eligibility and benefit verification represents the highest volume transaction for the medical industry, accounting for 54% of all medical administrative transactions
  • 16 minutes in time savings opportunity annually for electronic eligibility and benefit verification for the medical industry
  • $9.3 Billion in cost savings opportunity annually

Electronic remittance advice:

  • Adoption increased to 88% (the highest increase among the transactions)
  • $701M in cost savings opportunity annually for electronic remittance advice for the medical industry
  • 5 minutes in time savings opportunity annually for electronic remittance advice for the medical industry
Read the full 2023 CAQH Index Report here.

Ready to start reducing administrative costs and time? Get in touch!


Unpacking the CAQH Index Report: Health Plan Optimization Through Electronic Administrative Transactions

The Council for Affordable Quality Healthcare (CAQH) released their annual index earlier this month. Data from the 2023 CAQH index report sheds light on electronic administrative transaction adoption rates, time savings, cost avoidance, and the need for collaboration. The effects of the COVID-19 pandemic continue to be felt across sectors, adding to the strain of increasing costs, decreasing cost savings opportunities and increasing time spent on administrative tasks. Yet, there’s still hope. At UHIN, we’ve recognized similarly significant trends in our Clearinghouse transactions and claims management, specifically in claims submission and electronic remittance advice (ERA), and offer solutions that can move health plans to a more positive outcome for themselves and their members.

Our most intriguing takeaways from the 2023 CAQH index report:

  1. Volume increased
  2. Cost avoidance opportunities persist
  3. Collaboration & flexibility will be key moving forward
  4. Certain transactions make a big impact:
    • Claims submission (ASC X12N 837: request to obtain payment or transmission of encounter information for the purpose of reporting delivery of healthcare services)
    • Remittance Advice (ASC X12N 835: an explanation from a health plan to a provider about a claim payment)

1. Volume increased

The index report highlights that electronic transaction volume increased, but for one notable exception, in 2023 (for both payers and providers).

  • Electronic claim submissions increased from 8,751 to 9,476 
  • Claim status inquiry increased from 2,254 to 2,820 
  • Only Electronic remittance advice decreased, moving from 2,499 last year to 2,080 in 2023, marking a 22% decrease

We facilitate each of these transactions and provide other valuable services, like EDI enrollment, to health plans. Since 1993, we’ve empowered our customers to provide better care and better costs to their members. To this day, we remain at the vanguard of electronic data interchange (EDI) and interoperability. Are you ready to learn more about our claims management solutions?

2. Cost avoidance opportunities persist:

Overall, the estimated medical industry spend increased from $55 Billion to more than $82 Billion, driven primarily by staffing shortages coupled with volume increases. In tandem, cost savings opportunities decreased to $16.4 Billion. The report reveals that $89 billion, or 22% of National Healthcare Expenditures in the U.S., is spent on administrative transactions, with potential savings of $18.3 billion through fully electronic transactions. Health plans can still save more than $140 million annually by automating transactions:

Savings opportunities:

  • $104 million with electronic claims submissions 
  • $38 million by moving to electronic remittance advice

It’s important to remember that you don’t need to sacrifice quality when decreasing costs. UHIN provides high quality electronic claims management services at a comparatively low cost. We’ve been doing this for health plans for more than three decades and remain dedicated to our mission: Better costs and better care.

3. Collaboration and flexibility are key:

Looking ahead, the CAQH index report notes that the “industry will need to collaborate and remain flexible in order to identify opportunities and best practices, and respond to emerging and consistent challenges and business needs.”

We couldn’t agree more. Healthcare is complex and challenging. When UHIN looks at the fragmented nature of healthcare we know we need to act and be a force for change. As a central, neutral, community-created organization, we bring together all players in the healthcare environment to create a more connected healthcare system.

“With the data and technologies available to us today, we have the power to transform the way we conduct the business of healthcare. However, as an industry, we must align around consistent processes that enable providers to minimize the time spent learning new workflows. This is particularly important given the current labor shortage.”

Erin Weber, Chief Policy and Research Officer at CAQH (via CAQH)

4. Let’s dig into the transaction analysis:

Claims submission:

  • $2.1 Billion in cost savings opportunity annually for electronic claims submission for providers and payers combined
  • While electronic spend on claims by plans decreased in 2023 (from $576 Million to $517 Million), the total of costs avoided increased (from $4.2 Billion to $5 Billion)

Electronic remittance advice:

  • Adoption increased five percentage points across the medical industry to 88% (the highest increase among the transactions)
  • Medical volume decreased 22 percent
  • $701 Million in cost savings opportunity annually for electronic remittance advice across the medical industry
2023 CAQH index report
Read the full 2023 CAQH Index Report here.

Ready for better costs and better care? Get in touch! 


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 enrollment@uhin.org 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 enrollment@uhin.org 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!