NEHEN 3.0 is the project name for the creation of the future FHIR version of NEHEN, a cost-effective, collaborative, open standards-based exchange of clinical and administrative data, implementing priority use cases to move the community forward toward automation for prior authorization and quality measurements. It will meet customers where they are currently and provide a pathway to the future by supporting both X12 and FHIR-based clinical and administrative exchange.
Overview
NEHEN 3.0 represents the next phase of healthcare data exchange. Our goal is to combine the proven reliability of X12 EDI services with the modern flexibility of FHIR, offering our members a powerful, multi-purpose data exchange platform that’s ready for the future.
- Simplifies and consolidates the infrastructure for clinical and administrative health information exchange in a multi-payer, multi-provider collaborative setting.
- Brokered API transactions between payers and providers allowing for a single API connection.
- Supports both current X12-based (HIPAA-mandated) EDI transactions and new API/FHIR-based use cases, including electronic prior authorization (ePA), quality measures support, provider and patient access, and payer-to-payer exchange.
- Complies with Health Plan requirements for the prior authorization portion of the Interoperability and Patient Access Final Rule (CMS-0057-F).
- Optionally supports the Patient Access, Provider Access, Payer to Payer and Provider Directory API requirements under the CMS-0057 rule.
- Operates under a community-wide governance model to guide future features and use cases, maximizing value for participants.
- Vendor partners: Cognizant/TriZetto (X12 EDI) and ZeOmega (FHIR)
Features
- Cost-effective, collaborative, open standards-based exchange of clinical and administrative data initially focusing on prior authorization and quality measures use-cases
- Centrally hosted community asset delivery approach with shared support, onboarding and operational resources
- Common platform, set of tools, capabilities and services spanning across payers & providers for a coordinated approach
- Optional participation in hosting instances of shared CRD and DTR services for Health Plans
- Financial and operational governance at the community-level with a trusted non-profit organization (MHDC/NEHEN)
- Inclusion of other FHIR API exchange services, centrally hosted, plus optimized X12 EDI services via a service-model delivery approach in support of payer-provider collaborative workflows
- Continuous iterative delivery and advancement of innovative API based use-cases governed in a collaborative, community driven approach
- Meeting participants where they currently are technically while providing a pathway to the future
Status & Updates
We’re in the process of enrolling and planning the rollout of NEHEN 3.0 to all members, with a focus on a smooth, seamless implementation. Here’s a quick look at our timeline and key updates:
- Timeline: The initial phases of NEHEN 3.0 will be implemented starting in the first quarter of 2025.
- Member Participation: MHDC is actively engaging with interested participants to be early adopters and ensure implementation prior to the Jan 1, 2027 CMS-0057 rule deadline.
- Support: MHDC, Cognizant, and ZeOmega will provide various resources to help members successfully implement(this is confusing for current members – there is NO transition from the existing platform to the new)the new system with minimal disruption.
- Dual Platform & Flexibility: Users can continue to leverage X12 EDI while gradually integrating FHIR-based APIs into their workflows. NEHEN will be designed to support both existing data exchange processes and new, real-time FHIR services, allowing for a customizable approach.
- Initial FHIR API Transactions
Coverage Requirements Discovery (CRD) |
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Documentation Templates and Rules (DTR) |
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Prior Authorization Support (PAS) |
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FHIR-Based Quality Measures |
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Other Supported CMS APIs (optional) |
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