Not too long ago Healthcare Innovation interviewed Jay Nakashima about how his group, eHealth Trade, is taking part in a key function in Utah’s pioneering efforts round compliance with the CMS Interoperability and Prior Authorization Ultimate Rule (CMS-0057-F). Different states, together with Massachusetts, are additionally making progress on this entrance.
In June, the Massachusetts Well being Knowledge Consortium (MHDC), in partnership with vendor ZeOmega Inc., launched a community resolution to automate prior authorization and streamline scientific knowledge trade for high quality measurement amongst Massachusetts well being plans and suppliers.
MHDC explains that this initiative expands upon its New England Healthcare Trade Community (NEHEN) service.
The NEHEN service at the moment helps X12 Digital Knowledge Interchange (EDI) claims, eligibility, and referral transactions. The following era of the NEHEN service, NEHEN FHIR, will incorporate FHIR APIs to allow real-time, automated prior authorization and scientific knowledge trade for high quality measurement and reporting by way of a single connection.
The initiative helps compliance with the CMS Ultimate Rule and leverages HL7 Da Vinci Implementation Guides for prior authorization. It’ll additionally assist a FHIR model of MHDC’s High quality Measurement Specification to enhance scientific knowledge sharing for high quality measurement and reporting.
In August MHDC introduced that it has chosen to work with an organization referred to as Datycs on the FHIR model of its High quality Measurement Specification. NEHEN’s FHIR-based high quality measures service is predicted to assist bulk knowledge trade and measure-by-measure trade approaches.
Early adopters embrace Blue Cross Blue Protect of Massachusetts, Point32Health, (the mum or dad group of Harvard Pilgrim Well being Care and Tufts Well being Plan), and WellSense Well being Plan. These organizations are among the many first to start integrating with the improved NEHEN platform, serving to to put the inspiration for broader statewide adoption.
“Establishing a shared commonplace for high quality measure knowledge trade is important to decreasing complexity and administrative burden throughout the healthcare ecosystem,” stated Denny Brennan, govt director of MHDC, in a press release. “By aligning on a typical FHIR-based method for assembly state and federal reporting necessities, we are able to streamline knowledge assortment between payers and suppliers, enhance consistency, and in the end help organizations of their effort to focus extra time and assets on bettering affected person outcomes.”
