NEHEN 3.0

Updated NEHEN circle image

NEHEN 3.0 is the project name for the creation of the future HL7® 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 EDI and FHIR®-based clinical and administrative exchange.

*FHIR® is the registered trademark of HL7 and is used with the permission of HL7.

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 FHIR®/API-based use cases, including electronic prior authorization (ePA), quality measures support, provider and patient access, and payer-to-payer exchange.
Supports prior authorization requirements in 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
Hosted CRD and DTR services for those payers preferring that option
Financial and operational governance at the community-level with a trusted non-profit organization
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
Community governance model leveraging collaboration between MHDC, our NEHEN vendors, and our NEHEN users
Iterative development approach to advance NEHEN functionality and use cases on an ongoing basis
Meeting participants where they currently are technically while providing a pathway to the future

Status & Updates

We're in the process of rolling out the new NEHEN and signing up users for the new services. We expect a smooth implementation that seamlessly integrates with existing services. Here’s a quick look at our timeline and key updates:

Timeline: MHDC expects the initial implementation phase to start in Q1 2025.
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 resources to help members successfully implement new NEHEN features 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)	Passthrough FHIR® to payer’s hosted CRD rules engine Optional: Shared CRD service, hosted by NEHEN on behalf of our health plans
Documentation Templates and Rules (DTR)	Passthrough FHIR® to payer’s hosted DTR service Optional: Shared DTR service, hosted by NEHEN on behalf of our health plans
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 to transfer all quality measures data at once FHIR®-based measure-by-measure exchange addressing the needs of individual quality measures
Other Supported CMS APIs (optional)	Patient Access API Provider Directory API Provider Access API Payer-to-Payer API

Overview

Features

Status & Updates

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