Provider Worth

Enhancing the quality, safety, and efficiency of care

The New England Healthcare Exchange Network grew from a simple exchange of patient eligibility information in 1998 to a mature HIPAA-standard administrative transaction engine in partnership with the industry leader Trizetto Provider Solutions.

The benefits of using NEHEN’s solutions for administrative are manifold, from enhancing the quality, safety, and efficiency of care, to reducing costs, to gaining operational efficiencies from streamlining disparate technical processes for Revenue Management Cycle activities.

Picture of a doctor talking to a client in a clinic
Picture of two doctors walking in a hospital hallway to the door

Providers gained benefits from NEHEN

Members of NEHEN who are providers have gained benefits from using NEHEN for: 

With NEHEN, provider organizations have a single process and system for checking eligibility with multiple health plans. They have the flexibility to fully integrate eligibility verification into their hospital information system or use NEHEN’s own Web-based application to inquire on every patient that walks in the door.

NEHEN has dramatically reduced rework, improved collections, and enabled a higher degree of customer service and patient interaction at registration.

Using NEHEN’s batch functionality, providers automate their eligibility verification process by building an extract out of their scheduling/registration system to automatically check eligibility for all scheduled patients in advance. Later, they work the few exceptions where the insurance information in their system does not match the payer system. By checking eligibility beforehand, providers have the opportunity to correct insurance discrepancies before the patient arrives for their appointment.

Providers also use NEHEN’s batch functionality to automatically inquire on all unpaid claims by extracting a file directly out of the provider billing system and working the exceptions the following day. This acts as an alternative to inquiring on one claim at a time by calling the payer directly or using payer Web-sites.

NEHEN gives providers a single point to manage and track major claim volume often replacing many proprietary direct submissions with an automated claim submission process including: 

Real Cost Savings – Increased electronic transaction volume allows health plans to reduce the number of customer service… Read More.

Collaboration Benefits – Taking Costs Out of the System – With NEHEN, payer organizations avoid clearinghouse costs by directly… Read More.