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.

A membership-based consortium of regional health plans / payers and provider organizations

Powered by TriZetto Provider Solutions (TPS), offering Eligibility, CSI, Referral, and Claim Processing for most regional and national Payers at a consistent flat rate based on your organization’s needs.

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

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

Specialist Referrals

(278)
- Specialty care authorizations
- 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.

A doctor and patient consultation in a clinic
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
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.

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Get in touch with us
NEHEN Member Services
NEHENnet Technical Support