NEHEN 3.0

NEHEN 3.0 Infographi NEW

NEHEN 3.0 will be 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.

What is NEHEN 3.0

NEHEN 3.0 will focus on reducing burden and minimizing operational and capital expenditures for participating organizations, while advancing the exchange of clinical and administrative data between payers and providers
Through a common platform, NEHEN 3.0 will support both the X12 based (HIPAA mandated) EDI transactions, as well as new API / FHIR based clinical use cases
Initial services will include current EDI transactions such as eligibility verification and remittance advice (ERA), as well as FHIR transactions supporting initial use cases of prior authorization and quality measures
Community-wide governance will determine future features and use cases that offer the most value to NEHEN 3.0 trading partners

Features

Cost-effective, collaborative, open standards-based exchange of clinical and administrative data
Inclusion of FHIR API exchange services, centrally hosted plus optimized X12 EDI services via a service-model delivery in support of payer-provider collaborative use-cases
Initial focus on priority use cases for prior authorization and quality measures data exchange
Iterative delivery and advancement of API based use-cases governed in a collaborative, member driven approach
Meeting customers where they currently are technically, while providing a pathway to the future
Shared services delivery model with community governance in a collaborative, evolving, and adaptive planning process
Continual innovation, advancement, and adoption
Culture of serving end-user needs and operational workflows
Transparency among community and broader industry
À la carte service options depending on needs, including choice of passthrough transactions or hosted services when both are offered
Standards based exchanges with adaptations to meet members where they are today with a path to the future

FHIR API Transactions Planned for Phase I of NEHEN 3.0

Coverage Requirements Discovery (CRD)

Passthrough FHIR to payer’s hosted CRD rules engine
Shared CRD service, hosted by NEHEN on behalf of our health plans (optional)

Documentation Templates and Rules (DTR)

Passthrough FHIR to payer’s hosted DTR service
Shared DTR service, hosted by NEHEN on behalf of our health plans (future)

Prior Authorization Support (PAS)

Passthrough FHIR to payer’s prior authorization system for automated approval

FHIR-Based Quality Measures

FHIR-based bulk clinical data exchange (exchange all quality measures data at once).
Measure specific FHIR transactions (ex: QM & DEQM IGs)