New England Healthcare Exchange Network
Member-based consortium providing affordable, multi-payer administrative EDI services and tools that assist in reducing costs and playing an integral part in the end-to-end Revenue Cycle Management process.
Customer focused
Value oriented
Quality obsessed
People centric
What we do
The affordable, multi-payer administrative solution
Eligibility and Benefit Response
(270/271)
- Real-time integration with Billing & A/R systems
- Real-time single patient, single plans
- Real-time single patient, many plans
- Upload a batch from a spreadsheet of file
- Real-time single patient, single plans
- Real-time single patient, many plans
- Upload a batch from a spreadsheet of file
Claim Submission and Claim Status Inquiry
(837/835 & 276/277)
- Manage and track all claim files
- Direct entry of claims!
- View acknowledgments from the insurer
- Automated pick-up directly from payers
- Real-time, multi-payer, regardless of channel
- Upload a batch from a spreadsheet of file
- Direct entry of claims!
- View acknowledgments from the insurer
- Automated pick-up directly from payers
- Real-time, multi-payer, regardless of channel
- Upload a batch from a spreadsheet of file
Specialist Referrals
(278)
- Specialty care authorizations
- Outpatient authorizations
- Integrated eligibility check,
- ICD10 and CPT4 code set search
- NPPES search for NPIs
- Outpatient authorizations
- Integrated eligibility check,
- ICD10 and CPT4 code set search
- NPPES search for NPIs
Revenue Cycle Management
Accessing majority of Regional and National Payers in One Solution for Revenue Cycle Management
Accessing majority of Regional and National Payers in One Solution for Revenue Cycle Management
Payer Name | 270/271 eligibility | 2766/277 csi | 278 specialist referrals | 837 claim submission | 835 claim remittance | |
|---|---|---|---|---|---|---|
BCBS MA | D | ✓ | ✓ | ✓ | ✓ | ✓ |
Blue Benefit Administrators | ✓ | ✓ | ✓ | |||
Boston Medical Center Health Plan | D | ✓ | ✓ | ✓ | ||
Commonwealth Care Alliance | ✓ | ✓ | ✓ | |||
Fallon | D | ✓ | ✓ | ✓ | ✓ | |
Harvard Pilgrim Health Care | D | ✓ | ✓ | ✓ | ✓ | ✓ |
Health New England | D | ✓ | ✓ | ✓ | ✓ | |
Allways Health Partners (NHP) | D | ✓ | ✓ | ✓ | ✓ | |
Tufts Health Plan | D | ✓ | ✓ | ✓ | ✓ | ✓ |
Tufts Network Health | D | ✓ | ✓ | ✓ | ✓ | ✓ |
Aetna | D | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Cigna | D | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Connecticare | ✓ | ✓ | ✓ | |||
MA Medicaid | D | ✓ | ✓ | ✓ | ✓ | |
Medicare | ✓ | ✓ | ✓ | ✓ | ||
Oxford | D | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Tricare | ✓1($) | ✓ | ✓ | ✓ | ||
Unicare | ✓ | ✓ | ✓2($$) | ✓ | ✓ | |
United Healthcare Student Resources | ✓ | ✓ | ✓ | ✓ | ||
United Healthcare | D | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
legend:
P – Included in the fixed monthly subscription cost
P1 ($) – $0.05 per transaction
P2 ($) – $0.40 per transaction
[D] – Payers participating in real-time Discovery inquiries.
legend:
Non-NEHENnet Participating Additional Payers can be added from Trizetto Provider Solutions (TPS) from a list of over 8,000+ national and regional payers for incremental per-transaction fees.
Payer Name | 270/271 eligibility | 2766/277 csi | 278 specialist referrals | 837 claim submission | 835 claim remittance |
|---|---|---|---|---|---|
BCBS MAD | ✓ | ✓ | ✓ | ✓ | ✓ |
Blue Benefit Administrators | ✓ | ✓ | ✓ | ||
Boston Medical Center Health PlanD | ✓ | ✓ | ✓ | ||
Commonwealth Care Alliance | ✓ | ✓ | ✓ | ||
FallonD | ✓ | ✓ | ✓ | ✓ | |
Harvard Pilgrim Health CareD | ✓ | ✓ | ✓ | ✓ | ✓ |
Health New EnglandD | ✓ | ✓ | ✓ | ✓ | |
Allways Health Partners (NHP)D | ✓ | ✓ | ✓ | ✓ | |
Tufts Health PlanD | ✓ | ✓ | ✓ | ✓ | ✓ |
Tufts Network HealthD | ✓ | ✓ | ✓ | ✓ | ✓ |
AetnaD | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
CignaD | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Connecticare | ✓ | ✓ | ✓ | ||
MA MedicaidD | ✓ | ✓ | ✓ | ✓ | |
Medicare | ✓ | ✓ | ✓ | ✓ | |
OxfordD | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Tricare | ✓1($) | ✓ | ✓ | ✓ | |
Unicare | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
United Healthcare Student Resources | ✓ | ✓ | ✓ | ✓ | |
United HealthcareD | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Payer Name | 270/271 eligibility | 2766/277 csi | 278 specialist referrals | 837 claim submission | 835 claim remittance |
|---|---|---|---|---|---|
BCBS MA | ✓ | ✓ | ✓ | ✓ | ✓ |
Blue Benefit Administrators | ✓ | ✓ | ✓ | ||
Boston Medical Center Health Plan | ✓ | ✓ | ✓ | ||
Commonwealth Care Alliance | ✓ | ✓ | ✓ | ||
Fallon | ✓ | ✓ | ✓ | ✓ | |
Harvard Pilgrim Health Care | ✓ | ✓ | ✓ | ✓ | ✓ |
Health New England | ✓ | ✓ | ✓ | ✓ | |
Allways Health Partners (NHP) | ✓ | ✓ | ✓ | ✓ | |
Tufts Health Plan | ✓ | ✓ | ✓ | ✓ | ✓ |
Tufts Network Health | ✓ | ✓ | ✓ | ✓ | ✓ |
Aetna | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Cigna | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Connecticare | ✓ | ✓ | ✓ | ||
MA Medicaid | ✓ | ✓ | ✓ | ✓ | |
Medicare | ✓ | ✓ | ✓ | ✓ | |
Oxford | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
Tricare | ✓1($) | ✓ | ✓ | ✓ | |
Unicare | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
United Healthcare Student Resources | ✓ | ✓ | ✓ | ✓ | |
United Healthcare | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
legend
✓ – Included in the fixed monthly subscription cost
✓1($) – $0.05 per transaction
✓2($$) – $0.40 per transaction
[D] – Payers participating in real-time Discovery inquiries.
legend:
Non-NEHENnet Participating Additional Payers can be added from Trizetto Provider Solutions (TPS) from a list of over 8,000+ national and regional payers for incremental per-transaction fees.
legend
✓ – Included in the fixed monthly subscription cost
✓1($) – $0.05 per transaction
✓2($$) – $0.40 per transaction
[D] – Payers participating in real-time Discovery inquiries.
legend:
Non-NEHENnet Participating Additional Payers can be added from Trizetto Provider Solutions (TPS) from a list of over 8,000+ national and regional payers for incremental per-transaction fees.
legend
✓ – Included in the fixed monthly subscription cost
✓1($) – $0.05 per transaction
✓2($$) – $0.40 per transaction
[D] – Payers participating in real-time Discovery inquiries.
legend:
Non-NEHENnet Participating Additional Payers can be added from Trizetto Provider Solutions (TPS) from a list of over 8,000+ national and regional payers for incremental per-transaction fees.
experience excellence
The primary success factor
The primary success factor for NEHEN has been the collaboration between health plans and providers. The members of NEHEN believe that providing EDI (electronic data interchange) capabilities to their exchange partners represents an opportunity to improve administrative and clinical processes for the entire health care community.
Passion is what drives us
We’re not just determined about doing great work. We also love doing it.
What people say
Testimonials
This is a excellent company!
personally enjoyed the energy & the professional support the whole team gave to us into creating website.
Herman MillerGraphic Designer 
I wanted to hire the best and after
looking at several other companies,
knew Jacob was the perfect guy for the
job. he is a true professional.
Jeremy SmithCreative Head 
Their team are easy to work with and helped me make amazing websites in a short amount of time. thanks again guys for all your hard work.
Shoko MugikuraCreative Director 
Our Mission
We care deeply about what we do so that you can focus on you
You may be used to the traditional, competitive relationships between payers, providers, and intermediaries such as clearinghouses and wonder, “What makes NEHEN different?” The short answer is: nearly everything.
Let's discuss now
Get in touch with us
NEHEN Member Services
NEHENnet Technical Support
- Please Provide:
- Site ID
- Contact Name
- Call Back Number
- Reason for Emergency