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WEDI Newsletter | June 2018
Executive Corner | Why WEDI?
Media Spotlight: WEDI Featured in EHR Intelligence | Eligibility Survey
New Provider Information Subworkgroup | Workgroup Roundup
Latest Member News
Each month, the Executive Corner provides prominent WEDI leaders an opportunity to share their perspectives on a variety of topics impacting healthcare – from legislative matters and industry events to the headline-grabbing issues of the day.  
Dear WEDI Members,

Later this summer, we’ll be gathering in Chicago for an event that will bring two very important topics impacting our industry, front and center: Attachments and Prior Authorization. Although the latter is a topic for which we could dedicate an entire newsletter, I’d like to take this opportunity to focus a bit on attachments given how timely the topic is with CMS expected to release a notice of proposed rulemaking (NPRM) sometime in August.

Changing payment models, quality programs, disease management, care coordination and so on have necessitated dramatic changes for the exchange of clinical data between providers and health plans. Administrative and financial data is by and large standardized, and the technology is in place for that interchange. However, clinical data is much less so, complicated by the need for both images and text-based documentation, and the availability of technology that can facilitate that interchange is often lacking. As a result, healthcare is still very much a paper- and manual-based industry. By one estimate, hospitals spent over $9B last year alone in fax-related activities.

For providers, who typically interact with more than a dozen health plans, clinical data can be requested about patients in a variety of methods. If that isn’t enough, there are stories of several departments within the same health plan requesting essentially the same information about the same patient. In the case of fax transmissions, where there is no acknowledgement of receipt, a medical practice may fax the same information about the same patient multiple times, frustrating both the sender and receiver.

The industry is anxiously awaiting CMS to release a notice of proposed rulemaking (NPRM) on the standard for electronic attachments, which is expected to occur in August. While this release is both welcome and important, what I’m advising my clients, is that the standard alone is not the panacea that many are seemingly expecting it to be. There are deeper issues with clinical data exchange including the intricate balance between an organization’s workflow, process and integration. Both healthcare payers and providers need to evaluate and correct internal processes first while anticipating likely changes, so they can effectively utilize these incoming standards.

Technology serves as an enabler, not the means to an end. The hard work is tackling the business processes, making them more efficient, effective and timely. Does your organization have its ducks in a row when it comes to clinical data exchange?

Looking forward to continuing this important discussion and more at the WEDI Summer Forum.

See you in Chicago!

Jay Eisenstock , WEDI Board of Directors, Chair Elect
We surveyed WEDI Conference attendees on why they keep coming back to WEDI year-after-year. Here are the top five answers:

  1. In-depth, educational sessions that relate directly to my role
  2. Face-to-face meetings with experts, influencers and colleagues
  3. Raises the awareness of what I need to know on industry issues
  4. Access to best practices and insights on the latest trends in Health IT
  5. Outstanding networking sessions!
With so many reasons why WEDI conferences continue to draw our industry’s best and brightest, now is your chance to join us for our latest event: The WEDI Summer Forum .

The two-day summit will take place will take place July 31 - August 1, 2018 at the American Dental Association Conference Center in Chicago, and will bring together industry stakeholders to address inefficient administrative processes and the potential solutions that can be implemented to mitigate them. Your attendance would be a critical and appropriate addition as we look to continue WEDI’s mission to improve health information exchange – enhancing quality of care, improving efficiency and reducing cost. 

Day 1 of this two-day event will feature a presentation by Madhu Annadata, Director, Division of National Standards – Centers for Medicare & Medicaid Services, as well as high-level discussions focused on: 

  • Attachments Updates by Robert Bowman, CORE Director – CAQH CORE
  • A Look into the X12 275 and 277 Transaction
  • A Closer Look into the HL7 Consolidated CDA and the Use of Schema, Rick Geimer, Chief Innovation Officer- Lantana Group
  • A Deep Dive into the Use of LOINC Codes
  • How to Prepare for the Possible Federal Regulation

Day 2 presentations include: 

  • ONC, Prior Authorization and Clinical Burden, Dr. Thomas Mason, Chief Medical Officer, Office of the National Coordinator
  • Prior Authorization Updates from HATA and CAQH CORE
  • Prior Authorization and FHIR, Dr. Charles Jaffe, CEO, HL7
  • Prior Authorization and Pharmacy
  • An Update; Looking at January Consensus Statement on Prior Authorization

WEDI 2018 Summer Forum is open to all interested healthcare stakeholders across provider, payer, vendor and government entities. 

Members who buy 3 registrations will receive an additional registration for FREE.
Non-members who buy 4 registrations will receive an additional registration for FREE.

For WEDI Summer Forum sponsorship or exhibiting opportunities, contact Matt Downey at mdowney@wedi.org .
WEDI, SAFE-BioPharma Association, LLC, eHI, and eP3 Foundation are collaborating with the Electronic Healthcare Network Accreditation Commission (EHNAC) to launch a Trusted Exchange Accreditation Program (TEAP) to further improve healthcare data exchange and interoperability efforts.

To read the complete article, visit  EHR Intelligence .
This brief survey, which was developed by the Eligibility & Benefits Subworkgroup, will be used to help determine opportunities for improvement, or recommendations thereof, that will potentially help payers, providers and vendors/clearinghouses to realize a stronger return on investment and to overcome barriers to adopting the consistent usage of the ASC X12N 270/271 Eligibility & Benefit Inquiry & Response transaction set. Responses to the survey will be used by WEDI to identify the barriers to use of the transactions. Next steps will involve identification of opportunities to increase use of the transactions, with the goal of reducing manual effort, including phone calls between health plans and providers.

Please complete this brief survey by this Friday, June 29 th
WEDI workgroups and subworksgroups provide thoughtful leadership and common-sense approaches that enhance the exchange of clinical and administrative healthcare information. They collect input, exchanges ideas, and make recommendations that inspire impactful and far-reaching change in our industry. Recently, WEDI welcomed the addition of the new Provider Information Subworkgroup to our workgroup lineup.

Formed in February 2018, the objective of the new Provider Information Subworkgroup is to identify business issues impacting the transmission and receipt of provider data as well as engage stakeholders in a dialogue to determine needs, and requirements.

Lead by Co-Chairs Lisa Savicki, Humana, and Doreen Espinoza, DE Consulting , the subworkgroup is committed to understanding the nuances of the data along with industry successes and best practices for obtaining the information in a timely and accurate fashion.

The Provider Information Subworkgroup’s conference calls take place on the 2nd Monday of each month. Those interested in joining the call can contact sholvey@wedi.org for
dial-in information.
All of our workgroups have special projects and activities underway, here’s just a brief highlight of a few:

The Acknowledgements Subworkgroup has identified eight pain points associated with the 277CA and the 999 transactions. The subworkgroup has completed drafting a survey to help prioritize the pain points for future issue briefs or white papers. The survey is currently under review. If anyone would like to help provide clarity to the 999 and 277CA transactions please join the Acknowledgements Subworkgroup on the 2nd and 4th Wednesday of each month from 2:00 – 3:00 EST. 

The Eligibility and Benefits Subworkgroup has sent out a survey in an effort to determine the biggest barriers facing payers, provider and vendors/clearinghouse. The survey hopes to find solutions to reduce calls and increase usage of the electronic 270/271 transaction. Survey results will be reviewed and discussed at a future SWG meeting once the analysis is complete. 

The Remittance Advice & Payment Subworkgroup has completed the final review of the EFT Enrollment Security paper and will now be sending the document through the process for formatting and approval. The SWG will begin identifying their next work product.

The Provider Information Subworkgroup met Monday June 11th and agreed to create an Issue Brief defining “what is a provider”. While there are many types of providers, a definition of a provider as it pertains to provider information is what the subworkgroup will be focusing on. The subworkgroup will be going one step further to also define “what is provider data,” recognizing that this definition may vary depending upon the type of provider. If you are interested in participating with the development of this brief or be a part of the discussion, join them at their next meeting July 9th from 3:00 – 4:00 EST.
Health Plans/Systems
Technology Solutions/Vendors

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 tom@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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