Efficiencies & Decrease Manual Alternatives • WEDI conference presentations and/or webinars to share the information the SWG has compiled. www.wedi.org Dental Co-Chairs Patrick Cannady, American Dental Association Christine Ruiz, Delta Dental 8 Members: 25 Work Products:
2019 Workgroup Report Workgroup Leadership Committee Co-Chairs: Laurie Burckhardt, WPS Insurance Adele Allison, DST Health Solutions Pam Grosze, PNC Bank Workgroups Data Exchange · Acknowledgements · Attachments · Claims · Claim Status · Dental · Eligibility & Benefits · Prior Authorization · Property & Casualty · Provider Information · Remittance Advice & Payment www.wedi.org Genomics Payment Models Privacy & Security Telehealth Emerging Technology Subworkgroup Gender Coding Terminology 2 Data Exchange Workgroup Co-Chairs Pam Grosze, PNC Bank Ed Hafner, Change Healthcare Laurie Woodrome, LabCorp Acknowledgements Attachments Claims Claim Status Dental Eligibility & Benefits Prior Authorization Property & Casualty Provider Information Remittance Advice & Payment www.wedi.org 3 Acknowledgements Members: 34 Work Products: · Did You Know - In our acknowledgement survey, we identified a need to provide an issue brief providing education on some basic misunderstandings related to acknowledgements within HIPAA transaction exchange using the ASC X12 Version 005010 (5010). · Acknowledgements 101 Webinar - the history, regulations, purpose, scope, work flow, and transaction functions. Co-Chairs Tara Rose, Optum Jessica Malsom, BCBS of Kansas Ed Hafner, Change Healthcare www.wedi.org 4 Attachments Members: 49 Update: · During recent monthly calls the subworkgroup has been discussing the X12 Version 7030 275 Additional Information to Support a Health Care Services Review Change Log and Implementation Guide Released for Public Review. Co-Chairs Susan Langford, BCBS of Tennessee Durwin Day, BCBS Illinois www.wedi.org 5 Claims Members: 45 Work Products: · Claim Reporting for Appropriate Use Criteria for Advanced Diagnostic Imaging - The purpose of this issue brief is to provide information regarding the Center for Medicare & Medicaid Services' (CMS) Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging program. · Understanding the Models and Definitions of Encounters - Following an overview of encounters, it will explore various models and how data are exchanged between health care plans, payers, providers, and other entities, as well as define commonly used terms related to encounters. · Claims 101 Webinar - Provides the basics of the claim and its submission, as well as key issues facing the industry. Co-Chairs Rosemarie Hodges, Aetna Stanley Nachimson, Nachimson Advisors Beth Davis, Allscripts www.wedi.org 6 Claim Status Members: 34 Work Products: · Claim Status Survey 221 responses, which were reviewed in group calls · Upcoming projects: Provide education on business issues and recommendations related to the implementation and use of the claim status transactions. · Industry 276/277 Usage Survey to Payers, Providers and Partner Vendors · White paper - Claim Status Transaction Opportunities to Increase Efficiencies & Decrease Manual Alternatives · WEDI conference presentations and/or webinars to share the information the SWG has compiled. Co-Chairs Laurie Woodrome, LabCorp www.wedi.org 7 Dental Members: 25 Work Products: · Dental Claims White Paper - provide guidance on how to populate the ASC X12N 005010X224A2 Health Care Claim: Dental (837D) electronic transaction from the data reported on the ADA Dental Claim Form (© 2012 American Dental Association). · Working on ERA-EFT Reconciliation Resources for Dental Payers, Providers, and Vendors Issue Brief Co-Chairs Patrick Cannady, American Dental Association Christine Ruiz, Delta Dental www.wedi.org 8 Eligibility & Benefits Members: 34 Work Products: · Eligibility Survey · Working on a white paper about maximizing the eligibility and benefits transaction functionality for today's business needs Co-Chairs Donna Campbell, BCBS Illinois Evelyn Semataska, Aetna www.wedi.org 9 Prior Authorization Members: 41 Work Products: · Prior Authorization Survey - analyze the current medical services' PA process and help support the group in developing guiding principles to support increased automation and standardization. · WEDI Shares Results of Prior Authorization Survey in Testimony to NCVHS survey results highlighted technology limitations, increased PA requirements and the desire for mandated standards. Co-Chairs Heather McComas, American Medical Association Janice Bakos, Aetna Stephanie Bronshvayg, AthenaHealth www.wedi.org 10 Property and Casualty Members: 13 Work Products: · eBill States Document Provides a summary of state eBill regulations Co-Chairs Sherry Wilson, Jopari Solutions Tina Greene, Mitchell International www.wedi.org 11 Provider Information Members: 21 Work Products: · Provider Information Survey · Provider Information Webinar - What is Credentialing? Through the eyes of a consumer of healthcare, learn more about the who, what, when and how often a provider (practitioner and/or facility) should be credentialed. · Presentation at 2019 WEDI Winter Conference · Working on a Provider Information Definition issue brief Co-Chairs Heather Manuel, PNC Bank Michelle Barry, Availity www.wedi.org 12 Remittance Advice & Payment Members: 37 Work Products: · EFT Enrollment Security White Paper- recommends best practices to protect the security of all entities involved in Electronic Funds Transfer Enrollment. · 835 Balancing Webinar - Education and guidance to payers and providers on requirements within the 835 for financial balancing · Provider Adjustments (PLB) in the Electronic Remittance Advice (835) White Paper - provides guidance and information on the functionality and usage of the Provider Adjustment Segment (PLB) within the electronic remittance advice (ASC X12N 835 transaction) for specific business use cases · Pending approval updates to the PLB paper for Overpayment Recovery and Forward Balance · Working on a Remittance Advice & Payment 101 webinar Co-Chairs Pam Grosze, PNC Bank Mary Lynam, Argus Health Systems Margaret Richardson, Centene Corporation Deb Strickland, Individual Member www.wedi.org 13 Genomics Members: 11 Work Products: · Making Precision Medicine the Standard of Care Part 1 Clinical & Business Drivers - Leading health care systems, clinical laboratories, vendors and health plans are all increasing their focus on providing precision medicine (PM) through the use of genetic and genomic information. · Clearing a Path to Innovation in Clinical Genomics for Health Insurers webinar - covers the state of clinical genomics today from a cross-industry perspective and explore next steps in identifying opportunities for innovation, both in the near term and long range. · Working on a white paper regarding issues for health care insurers supporting clinical genomics for members. Co-Chair Grant Wood, Intermountain Healthcare www.wedi.org 14 Payment Models Members: 30 Work Products: · Alternative Payment Models and Risk-Bearing webinar - examines the 4 most common barriers to success as payers and providers share in patient risk. · Enabling Hybrid Electronification in Healthcare Payments and Remits with AI · Working on an issue brief providing clarity on issues related to the Alternative Payment Model (APM) Framework . Co-Chairs Adele Allison, DST Health Solutions John Kelly, Edifecs www.wedi.org 15 Privacy & Security Members: 37 Work Products: · Comment Letter: NIST Privacy Framework - response to the National Institute of Standards and Technology (NIST) proposed Privacy Framework as published in the Federal Register on September 9, 2019. · Comment Letter: Substance Use Disorder Patient Records Proposed Rule - on (SAMHSA's) Confidentiality of Substance Use Disorder-Patient Records Notice of Proposed Rulemaking (Proposed Rule). We applaud SAMHSA for continuing to align the SUD regulations with advances in health care delivery aligned with the protection of individuals' privacy related to treatment for SUDs. Co-Chairs Marilyn Zigmund Luke, AHIP Tina Grande, Healthcare Leadership Council www.wedi.org 16 Telehealth Members: 18 Work Products: · Updated Telehealth Resource Guide - provides a list of telehealth resources · Overcoming Barriers to the Broader Adoption of Telehealth - The purpose of this paper is to explore the current barriers and how to overcome them to achieve greater adoption of telehealth. The paper will focus on virtual visits and remote patient monitoring. · Webinar: Just What are the Barriers to Broader Adoption of Telehealth - The Telehealth Workgroup conducted the survey in the fall to learn from providers, payers, and patients about the advantages and disadvantages they have experienced or perceive related to the delivery of health care services through telehealth. With 200 responses, the results give insights into what the industry can do to further expand telehealth services. Co-Chairs Nancy Spector, American Medical Association Alison Armstrong, Anthem BC of California www.wedi.org 17 Emerging Technology This Subworkgroup under the Data Exchange Workgroup will be responsible for the education of new clinical data exchange processes (including underlying technologies) and addressing business challenges. If membership has some significant business challenges with this exchange, we can address those issues in this group through issue briefs, white papers, webinars, and/or conference sessions. This group will coordinate with and educate other Data Exchange Subworkgroups about the adoption of HL7 administrative exchange such as prior authorization, eligibility, and attachments. Co-Chairs Laurie Darst, Mayo Clinic Cherie Holmes-Henry, NextGen Healthcare Christol Green, Anthem www.wedi.org 18 Gender Coding This workgroup has been created to address the ongoing issue with Gender codes. There are many states that have develop new state laws to address gender identity. Each SDO has their own method of identification but has not been able to address the entire issue of gender coding for clinical and administrative usage. This workgroup will develop best practice/approaches on awareness of how data is reported, used and socialized. Included in the work will be working on patient advocacy issues/concerns. Help industry address the difference of how a patient may identify themselves versus patient gender when services are being rendered & recorded. Co-Chair Gail Kocher, Blue Cross Blue Shield Association www.wedi.org 19 Terminology Within SDOs and including WEDI, workgroups are struggling with definitions and terminology. The words across SDOs are used inconsistently making conversations very difficult when you need to bridge administrative with clinical data. WEDI will bring SDOs and industry leaders together to develop glossary of terms and definitions for the entire industry. The product developed will be an ongoing process as items change, new terms are needed. Document will be shared with all. Co-Chairs TBD www.wedi.org 20 WEDI is proud of the work it accomplished in 2019 and could not have achieved the outcomes without the dedicated efforts of its multi-stakeholder member volunteers. We look forward to continuing our work in 2020. www.wedi.org 21macOS Version 10.14.6 (Build 18G1012) Quartz PDFContext