Three vendors—a health information service provider, a payer contractor and a document management firm—are forming a task force to set industry standards for transactions supporting clinical data exchanges between providers and insurers.
The partners include:
• Secure Exchange Solutions, which facilitates secure clinical information exchange between hospitals, physicians, post acute providers, health plans and consumers
• Noridian, the Medicare contactor supporting administrative processes such as medical review, electronic data interchange, claims processing, provider enrollment and population health management services
• Medforce Technologies, which handles document and process management, claims and reimbursement, mailroom, accounts payables, human resources and denials management processes
The goal is to establish structured formats that will contribute to improved workflows for providers, insurers and suppliers by streamlining acquisition of provider digital signatures and the exchange of clinical documentation to support orders, pre- and post-claim needs and medical risk adjustment.
While there are defined guidelines for health record exchange and electronic prescribing, there are no standards for how health plans request and receive clinical documents to support workflows, says Dan Kazzaz, CEO at Secure Exchange Solutions.
The collaborating organizations hope to design an approach that uses the Direct messaging standard for exchanging health information along with the Clinical Document Architecture (CDA) data exchange standard of Health Level Seven to share data via a continuity of care document.
For example, a standard could support a patient referred to a home health provider and needing insurance approval, Kazzaz explains. The home health agency would conduct an assessment of the patient and then send it to a physician to sign and return to the home health provider, who then can send it to the payer for approval.
This process would support other types of referrals as well, such as durable medical equipment and ancillary providers with messaging capability embedded in information systems and mobile applications.
The standards won’t define how information in a message gets used, but will make it possible for electronic health records and mobile apps to collect the information.
Medforce’s document management system then will collect data and send it to the appropriate payers. “This is B2B messaging: app to consumer, app to app, or consumer to consumer,” according to Kazzaz. “What we’re trying to do is to help everybody communicate better.”
To raise awareness, Secure Exchange Solutions and its partners will conduct a Web seminar on May 11, followed with an in-person meeting in June during the X12 electronic data exchange conference in San Antonio.
“We are trying to lift the work from everyone in a way that can be adopted by any software vendor,” Kazzaz adds. More information is available here.
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