Implementing NEHEN has changed the way administrative processes are done in member organizations. Today, NEHEN participants already transmit all HIPAA Administrative Transactions such as:
- Eligibility Verification
- Specialty Care Referrals
- Authorization / Pre-Certification
- Referral Inquiry
- Claim Status Inquiry
- Claim Submission
- Electronic Remittance
NEHEN's membership includes leading regional payers such as Blue Cross Blue Shield, Harvard-Pilgrim Health Care, MassHealth, Neighborhood Health Plan, Network Health, BMC HealthNet Plan, Health New England, and Tufts Health Plan. NEHEN also has built exchange adapters to Medicare, Anthem of New Hampshire, and national payers such as Aetna, United, and Cigna.
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full supported transaction and payer list
NEHEN also facilitates clinical data exchange, moving continuity of care documents (CCD) for the exchange of clinical discharge summaries. The content-agnostic NEHEN clinical data exchange (CDX) framework will also be leveraged for:
- Clinical Referrals / Reasons for Referral
- Problem Lists
- Encounters
- Quality data reporting
- Immunization and syndromic surveillance reporting