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Dear WEDI Members,

April has been an incredibly busy and exciting month for us at WEDI, as well as the industry. With new proposed rules and regulations making headlines to being less than a month away from our WEDI Spring Conference, there is no shortage of information and perspectives for us to share – as you’ll see within this month’s articles and our regular email updates and announcements. We encourage you all to review and take part in our recommendations and the planning sessions and webinars around such. If you’d like to become more involved, please don’t hesitate to contact Samantha Holvey at sholvey@wedi.org and we will get you connected!

Additionally, I encourage you all take the opportunity to join us at not only the Spring Conference in beautiful San Diego, but our Summer Forum in Chicago at the end of July! These in person events provide an energy unlike any other as our membership and a cross-section of the healthcare industry all come together to collaboratively address the issues impacting health IT. I hope to have the opportunity to connect with each of you onsite and discuss the ways in which our organization can grow in helping your business success in this industry.

See you in San Diego!

Charles Stellar
WEDI President & CEO
Have you seen the latest sessions and details added for WEDI’s Spring Conference? With less than a month away from this exciting event, be sure to secure your seat to hear from the brightest minds in the industry in sessions that are idea-focused, foster learning and provoke conversations that matter. Register today to be a part of such topics as:

  • Keynote: The Impact of ONC’s Proposed Role and How it Could Impact Patient Care – Elise Sweeney Anthony, JD, Executive Director, Office of Policy, ONC
  • FHIR: Zero to 60 in Three Months – Rick Geimer, Lantana Group and Viet Nguyen, Da Vinci Project
  • Women in Healthcare Breakfast – Elissa Thaxton VP, Care Delivery Technology Services (CDTS) KP HealthConnect (Epic EMR system)
  • The Imperatives for Interoperability Standards in the Future of Healthcare and Plecosystem Economy – Dr. John Mattison, CMIO and Assistant Medical Director, Kaiser Permanente
  • NCVHS Update: Recommended Reform for Improved Interoperability – Alix Goss, NCVHS
  • New Industry Technology & Machine Learning Tech Showcase – Pat Bollom, CEO and Patrick Bores, CIO, Smart Data Solutions
  • Part II: HATA Industry Roadmap for EDI Implementation & Information Exchange – Spotlight on the CMS/ONC Proposed Rules and NCVHS Recommendations – Chris Bruns, HATA/MedInformatix; Robert Tennant, MGMA; Betty Lengyel-Gomez, Medinformatix; and Tammy Feenstra Banks, Optum 360
  • Understanding the Models, Transactions, and Data Flows of Encounter Data Reporting – WEDI Claims Subworkgroup Co-Chairs
  • The Changing Dynamic in Healthcare Security: The risk or the promise? – Charles Aunger, Managing Director, Health 2047
  • Evaluating the Benefits of ICD-10 and Looking to ICD-11 – Rich Landen
  • New Issues in Privacy & Security – Tina Olson Grande, Sr Vice President, Policy, Healthcare Leadership Council and Marilyn Luke, Vice President, America’s Health Insurance Plans
  • Delivering More Efficient Prior Authorization and Attachment Electronic Transactions through Operating Rules – Rachel Goldstein, Manager, CORE and Taha Anjarwalla, Manager, CORE
  • Panel: Preparing for the Interoperability Ecosystem – Lee Barrett, Executive Director, CEO, EHNAC. Panelists TBA
  • Mandates are Back on the Menu! – John Kelly, Principal Business Advisor, Edifecs
  • Artificial Intelligence: Embracing Healthcare’s Next Big Challenge – Dr. Joe Cunningham, Managing Director, Sante’ Ventures
  • Examining Interoperability and Data Exchange: A CEO Perspective – John Baackes, CEO, LA Care
  • WEDI Expert Panel Discussion on ONC and CMS Rules – WEDI leadership
  • Blue Button Demo Tech Showcase
  • The Documentation Requirement Lookup Service Initiative and a Review of CMS’ NPRM – Robert Dieterle, CEO, EnableCare and Sagran Moodley, Senior Vice President, Clinical Date Services and Technology, UnitedHealthcare
  • Using Analytics to Identify Departures from Medical Coding Standards – Michele Hibbert-lacobacci CCSP, OHCC, Senior Vice President, Regulatory Compliance Management, Mitchell International 
  • Inevitable Needs, Opportunity and Benefits of Telehealth for the Aging Population – Michael Kurliand, Director of Telehealth, West Health
  • Best Practices for EFT Enrollment Security – Margaret Richardson, EDI Manager, Centene Corporation and Heather Manuel, Vice President, PNC Bank, WEDI Remittance Advice and Payment Subworkgroup
  • 2018 CAQH Index® Findings: Immediate Opportunities to Save Time and Reduce Business Costs – Kristine Burnaska, Director, CAQH Research & Measurement Explorations
  • Value or Cost: Electronic Claim Status Request and Response – Chris Muschong, Kunz, Leigh and Associates and Tammy Banks, Claim Status Subworkgroup Co-Chairs 
  • Provider Adjustments (PLB) in the Electronic Remittance Advice (835) – How do they work? –Patricia Wijtyk, Cognizant and Pamela Grosze, PNC representing the WEDI Remittance Advice and Payment Subworkgroup
  • Anatomy of Value-Based Payment: An Interactive Discussion – Adele Allison (DST, WEDI Payment Models Workgroup)
The U.S. Department of Health and Human Services (HHS) announced it is extending the public comment period by 30 days for two proposed regulations aimed at promoting the interoperability of health information technology (health IT) and enabling patients to electronically access their health information. The new deadline for the submission of comments – June 3, 2019 – will allow additional time for the public to review the proposed regulations. To summarize, the following is a quick reference set of links to applicable documents. 
ONC and CMS Interoperability Proposed Rules
HIPAA Right of Access, Apps, and APIs

Trusted Exchange Framework and Common Agreement (TEFCA)
  • The second draft of the TEFCA, the second draft of the MRTCs, and the first draft of the QHIN Technical Framework were posted at http://healthIt.gov/TEFCA where you can also submit your comments.
  • Comments for all three TEFCA documents are due June 17, 2019.
Notice of Funding Opportunity (NOFO): Trusted Exchange Framework Recognized Coordinating Entity (RCE) Cooperative Agreement
Acknowledgements 101 Webinar
Tuesday, May 7, 2019 (3:00-4:00 p.m. ET)

Join us as we work through the history, regulations, purpose, scope, work flow, and transaction functions. A certificate of education is available for this webinar. WEDI is hosting this webinar FREE for members , and non-members are also welcome to
attend for a cost of $199.
Care Delivery Redesign Using Health IT
Wednesday, May 8, 2019 (3:00-4:00 p.m. ET)

The changing economics of healthcare is altering the traditional payer-provider business model. Provider consolidation, team-oriented and accountable care delivery, and emerging alternative payment models (APMs) are requiring all stakeholders to redefine and redesign. Quality, value and payment have begun to intersect. Using technology as a change agent, plans must now shift from long-established practices of managing healthcare – resource-focused – to managing health through member-focused and payer-provider aligned processes. This session will introduce and investigate shared and owned technologies and processes that align with industry mega-trends emerging from consumer expected value-based care.
Join Adele Allison, a leading policy expert, to gain insight into growing trends, technical needs and administrative challenges under emerging economic models, which are transforming plan roles from simple cost containment to health-value management.
By the end of the presentation, attendees will be able to:
1. Lead the discussion with others as to the value-proposition established through management of health value.
2. Articulate the role of technology and related processes to achieve health value management.
3. Formulate strategies in that align with mega-trends for health outcomes, quality and value measurement to drive healthcare economics.
A certificate of education is available for this webinar. WEDI is hosting this webinar
FREE for members , and non-members are also welcome to attend for a cost of $199. 
Health Care Trends for 2019 Webinar
Tuesday, May 14, 2019 (3:00-4:00 p.m. ET)

Every year, health care experts and insiders try to predict what the top health care trends will be for the year. Which initiatives, technology, and issues from the previous year will still be priorities? What is new this year? How will these trends drive health care over the next year? 

Amanda Coleman, Research Associate with the American Medical Association, will present research compiled by the Environmental Intelligence team on what they believe will be the 2019 health care trends. Ed Hafner, Senior Strategist with Change Healthcare, will also share his insights on top trends in revenue cycle management.

WEDI is hosting this webinar FREE for members , and non-members are also welcome to attend for a cost of $199.
Webinar: Are you ready? What you need to know about
FHIR and APIs to prepare for new CMS and ONC proposed rules
Thursday, May 16, 2019 (1:00-2:00 p.m. ET)

The writing is on the wall – it’s time to modernize and move from legacy standards to new innovative standards like FHIR and web-based APIs. Are you equipped to make the transition confidently? Join Edifecs for a special pre-conference webinar to learn how API adoption impacts your business cases as well as the right implementation and maintenance strategy to adopt for success.

Registration is hosted by Edifecs, making this webinar FREE for members and
This month, the Department of Health and Human Services (HHS) will launch its Compliance Review Program , an audit to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) rules for electronic healthcare transactions. As the nation’s leading nonprofit authority on the use of health IT to create efficiencies in healthcare information exchange and a statutory advisor to the U.S. Department of Health and Human Services (HHS), WEDI on April 11, 2019 issued the following statement on behalf of its President and CEO, Charles Stellar, lauding the department on initiating the audits:

“WEDI commends the launch of the Compliance Reviews. In general, the industry as a whole − providers, health plans and clearinghouses − have encouraged HHS to take steps to ensure compliance with HIPAA electronic transaction standards and operating rules. The Compliance Reviews are a good step toward greater adoption of standard administrative electronic transactions which means greater cost and time savings for all parties involved with healthcare billing and payments. Ultimately, greater use of electronic transactions in healthcare will mean lower healthcare costs for consumers.”

The audits will evaluate the most common administrative transactions that health plans conduct with providers. Health plans and clearinghouses will be audited for compliance with standardized formats and operating rules that have been adopted under the HIPAA Administrative Simplification provisions.

Starting in April, nine HIPAA-covered entities will be randomly selected for compliance review. Any clearinghouse or health plan, including fully and self-insured plans, may be chosen, regardless of whether they work with Medicare or Medicaid.

Transactions that may be reviewed include the healthcare electronic funds transfer (EFT) and remittance advice , and responses to eligibility for benefits requests and claim status requests . CMS will test these transaction files and ask entities to attest to whether the transactions comply with operating rules.

In the coming weeks, WEDI will host a webinar for members to discuss these audits and their implications on healthcare. For more information on the Compliance Reviews, read the FAQs and “Prep Steps” from CMS. 
All of our workgroups have special projects and activities underway, here’s just a brief highlight of a few:

  • The Remittance Advice & Payments Subworkgroup has completed the first iteration of the paper on Use of the PLB in the 835 Transaction, which includes information on reporting Interest and Prompt Pay Discounts in the PLB segment. It is going through the review and approval process and should be available soon. The group will be presenting two sessions at the Spring Conference and will be meeting face to face on May 20 at the conference – come and meet with us!
  • The Privacy & Security Workgroup is currently working on a response for the ONC and CMS regulations.
  • The Payment Models Workgroup is seeking to augment expert participation. The recently released CMS/ONC proposed rules on interoperability will have significant impact on alternative payment models and value-based payment. Therefore, we are in recruitment mode and we need your help identifying subject matter experts (SMEs) within your organization or those you know through interaction, in the following domain areas:
  • Open API/FHIR interoperability operations and implementation of technology and processes for value-based care, prior authorization, performance measurement, risk adjustment, and Stars.
  • Transport and content standards, experts with the knowledge of or engaging in collaboration with:
  • Vocabulary standards
  • X12 275 transaction
  • FHIR
  • Value-Based Care
  • Da Vinci, ONC P2 FHIR Task Force, and/or interoperability, generally
  • EHR, technical knowledge
  • If you are a SME, please join us for an upcoming call. We also welcome those seeking to learn.
  • The Eligibility & Benefits Subworkgroup is currently working on the Issue Brief content for the “Did ya know you could that!? (with the 270/271)”
  • The Genomics Workgroup will begin working on, “Issues for health care insurers supporting clinical genomics for members” white paper. The goal will be to bring together in one document all the current issues, but also the changing policies and market possibilities, for coverage of clinical genomic services. Topics will range from a high level point of view – what is the value of genomic testing to insurers and their members, especially with predictive vs. diagnostic vs. treatment guidance, supporting distinct clinical indications, purposes, and benefits – to what is the Payer support of the concept of a member (patient) genomic profile in a fully queryable database, for access during the patient’s lifespan, and linked to the patient EHR – to the Payer viewpoint on policy for cascade and family testing, incidental findings, and re-interpretation of results – and to the Payer viewpoint of genomics and artificial intelligence. This is just of few of the topics we’ll cover, with several more to be considered. Please join us for this exciting new project.
  • On 3/28, the Telehealth Workgroup held a webinar and reviewed the findings from its fall 2018 survey on barriers to the broader adoption of telehealth. The results were thought provoking and generated good discussion both in the workgroup and on the webinar. The common themes among the provider, patients and payers that responded were that payment policies, regulations and legislation, privacy and security, and knowledge of telehealth are the barriers to its adoption. The workgroup is now taking the survey findings and writing a white paper on overcoming those barriers.
WEDI has an incredible group of member organizations that recognize the value our organization brings to them professionally, as a company and as an industry advocate.
Here are some of our newest members. Please join us in welcoming them!
Interested in finding out which other organizations value WEDI membership just as much as you do? View our full listing of WEDI Members here .
This month, the Department of Health and Human Services (HHS) will launch its  Compliance Review Program , an audit to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) rules for electronic healthcare transactions. WEDI, the nonprofit organization that industry turns to for information on using health IT to improve efficiencies in healthcare information exchange, praised the move in an April 11 press announcement.

“WEDI commends the launch of the Compliance Reviews. In general, the industry as a whole − providers, health plans and clearinghouses − have encouraged HHS to take steps to ensure compliance with HIPAA electronic transaction standards and operating rules,” said President and CEO, Charles Stellar in the statement. WEDI is also and a statutory advisor to the U.S. Department of Health and Human Services.

To read the full article, visit Healthcare Purchasing News.
In one of our latest videos taken at the WEDI National Conference, Dr. Jack Lewin, Board of Directors of National Coalition on Healthcare outlines the value of the Trusted Network Accreditation Program.
Visit the WEDI Vimeo Channel to view our entire video library!
The two-day forum offers attendees the opportunity to ask questions and offer thoughts on some of the most important issues in Health IT and interoperability. Your attendance is a critical addition as we look to continue WEDI’s mission to improve health information exchange- enhancing quality of care, improving efficiency and reducing cost. Stay tuned for more details coming soon!
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If you are a WEDI Corporate Member organization and would like to have your press releases included in a future edition of the WEDI Monthly Newsletter, please email with a link to your press release to jennifer@andersoni.com .
The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of the American healthcare system. Formed in 1991 by the Secretary of Health and Human Services (HHS), WEDI was named in the 1996 HIPAA legislation as an advisor to HHS and continues to fulfill that role today.
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