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.
The affordable, multi-payer administrative solution
Eligibility and Benefit Response
- 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
- 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
- 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($$) | ✓ | ✓ |
Non-NEHENnet Participating Additional Payers can be added from Trizetto Provider Solutions (TPS) from a list of over 8,000+ national and regional payers for incremental per-transaction fees.
Payer Name | 270/271 eligibility | 2766/277 csi | 278 specialist referrals | 837 claim submission | 835 claim remittance |
---|---|---|---|---|---|
BCBS MAD | ✓ | ✓ | ✓ | ✓ | ✓ |
Blue Benefit Administrators | ✓ | ✓ | ✓ | ||
Boston Medical Center Health PlanD | ✓ | ✓ | ✓ | ||
Commonwealth Care Alliance | ✓ | ✓ | ✓ | ||
FallonD | ✓ | ✓ | ✓ | ✓ | |
Harvard Pilgrim Health CareD | ✓ | ✓ | ✓ | ✓ | ✓ |
Health New EnglandD | ✓ | ✓ | ✓ | ✓ | |
Allways Health Partners (NHP)D | ✓ | ✓ | ✓ | ✓ | |
Tufts Health PlanD | ✓ | ✓ | ✓ | ✓ | ✓ |
Tufts Network HealthD | ✓ | ✓ | ✓ | ✓ | ✓ |
AetnaD | ✓ | ✓ | ✓2($$) | ✓ | ✓ |
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($$) | ✓ | ✓ |
✓ – Included in the fixed monthly subscription cost
✓1($) – $0.05 per transaction
✓2($$) – $0.40 per transaction
[D] – Payers participating in real-time Discovery inquiries.
Non-NEHENnet Participating Additional Payers can be added from Trizetto Provider Solutions (TPS) from a list of over 8,000+ national and regional payers for incremental per-transaction fees.
✓ – Included in the fixed monthly subscription cost
✓1($) – $0.05 per transaction
✓2($$) – $0.40 per transaction
[D] – Payers participating in real-time Discovery inquiries.
Non-NEHENnet Participating Additional Payers can be added from Trizetto Provider Solutions (TPS) from a list of over 8,000+ national and regional payers for incremental per-transaction fees.
✓ – Included in the fixed monthly subscription cost
✓1($) – $0.05 per transaction
✓2($$) – $0.40 per transaction
[D] – Payers participating in real-time Discovery inquiries.
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.
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.
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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