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Executive Corner | FHIR, TEFCA, Interoperability Take Center Stage
Make Your Plans Now for WEDI Summer Forum
Reminder for CMS and ONC Comment Period | Upcoming Webinars
WEDI Releases New White Paper | Workgroup Roundup
WEDI Member Spotlight | Media Spotlight | Featured Video on Demand
Latest Member News
Thank you to all who were able to join us last week in San Diego for another successful and extremely engaging series of high-level discussions on the important topics continuing to impact the health care landscape. We’re looking forward to continuing that dialogue into specific areas focused around EDI, API, the latest technological mandates, prior authorization, data exchange, among other topics at our Summer Forum on July 30-31. I encourage you all to attend that as well. These in-person educational events are incredible opportunities to network with colleagues and get the answers to those questions impacting your business or that you’re struggling to tackle yourself.

As you’ll see mentioned in this newsletter edition, WEDI has no shortage of activities underway. Our association is committed to driving the impactful discussions between stakeholders – to include the legislative and regulatory activities taking place in health care. Many thanks to all of our workgroup and committee members and volunteers for your time and dedication to our association, our mission and the health care industry as a whole.

Charles Stellar
WEDI President & CEO
We can’t imagine there was a health IT acronym missing from last week’s WEDI Spring Conference talks! Such enlightening sessions with acute focus on real case examples, implementation strategies and what this means for our industry and how we get there! We hope you all walked away with a greater understanding of the issues. Thank you to the many sponsors, speakers, staff and attendees that made this event an incredible gathering of nearly 250 industry professionals. We look forward to seeing you at our other 2019 event – our education committee is working hard to provide the speakers and topics that are most relevant and of interest to you!
Join us for WEDI’s 2019 Summer Forum: Bridging EDI to API – Working for Today, Preparing for Tomorrow ! Registration is NOW OPEN!

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. Such topic areas to be covered include:

  • New Technological Mandates
  • EDI to API: Compare and Contrast
  • Innovations in Connectivity: From SFTP to REST
  • Payer Data Sharing: Payer-to-Payer and Payer-to-Member
  • Payer-Provider Data Exchange – Going Beyond HIPAA
  • New Technology – How the Standards Work Together
  • State of Prior Authorization
  • Payer Initiatives using Prior Authorization and Attachments
  • Deep Dive on a Workflow for the 278, Attachments and FHIR working together

WEDI 2019 Summer Forum is open to all interested healthcare stakeholders across provider, payer, vendor and government entities.
The U.S. Department of Health and Human Services (HHS) public comment period for the ONC and CMS NPRM Interoperability Proposed Rules deadline is June 3, 2019.

How to kill the fax machine in 6 steps
Thursday, June 13, 2019 (2:00-3:00 p.m. ET)

Despite the lack of a mandated standard, health plans are moving forward with projects to implement electronic medical attachments in an effort to reduce the costs associated with faxing and mailing medical records. The success of these initiatives will ultimately depend on getting providers to stop faxing and start attaching, but adoption shouldn’t be something health plans think about after building the model and rolling it out. Instead, they need to engage with providers and vendors at each phase of the process—from planning to implementation to scaling.

Availity’s role at the intersection of provider and payer connectivity has given them unique insight into the challenges and opportunities electronic medical attachments bring to the industry. They’ve been working closely with health plans, providers, and vendors to build a repeatable model for implementing electronic attachments that takes into consideration provider adoption and scalability. In this webinar, you will hear what they’ve learned throughout this process.

In this webinar, you will learn: 
  • Why aligning health plan and provider goals is critical 
  • The importance of building provider journey maps and managing expectations 
  • What factors to consider before establishing KPIs 
  • How medical attachments can help lay the foundation for an enterprise clinical gateway model

WEDI is hosting this webinar FREE for members and non-members.
Alternative Payment Models and Risk-Bearing
Wednesday, July 10, 2019 (3:00-4:00 p.m. ET)

In the early 1970s, David Bowie released the song Changes telling the world to “turn and face the strange.” Easier said than done. The new millennium has brought on rapid change in the way care is delivered, reimbursed and measured. Value in healthcare is now measured by the health status of patient populations. More and more, alternative payment models (APMs) are requiring providers to think beyond their individual patient populations to community-wide consumers of their services under risk-bearing arrangements. Health plans have been in the community-based risk management business for decades. As the payment paradigm moves risk to provider communities, the role of community-wide risk management becomes more essential to providers. Join us as we examine the 4 most common barriers to success as payers and providers share in patient risk.  
By the end of the presentation, attendees will be able to: 
  1. Identify alternative payment model (APM) archetypes and operational considerations. 
  2. List the four considerations to successful risk-bearing contracts. 
  3. Formulate strategies for rational risk-bearing that contemplates alignment of payer measures through an alternative payment model. 

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.
Clearing a Path to Innovation in Clinical Genomics for Health Insurers
Wednesday, July 16, 2019 (3:00-4:00 p.m. ET)

Genomics is the study of the entirety of our DNA, and Genomic Medicine is its application to clinical care. But there are a wide range of genomic information exchange issues – including genomic data formats and system interoperability, the storage, management, and governance of large data sets, privacy and security controls, care coordination and payer-provider collaboration. 
This webinar will cover 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. This will include a discussion of priorities, like standardization and what does the insurer industry really need. 

WEDI is hosting this webinar FREE for members , and non-members are also welcome to attend for a cost of $199.
A few weeks ago, we announced the release of a new WEDI industry white paper, written by the WEDI Remittance Advice and Payment Subworkgroup. “Provider Adjustments (PLB) in the Electronics Remittance Advice (835)”  offers guidance and information on the functionality and usage of the PLB within the electronic remittance advice.
According to the paper, “The PLB segment has historically been problematic for both payers and providers. Payers often do not provide all the necessary information in the 835 and providers often are not able to correctly interpret the information provided.”

The 23-page document outlines specific business use cases for the PLB and how information should flow from the payer to the provider. The paper’s authors go on to note how, “it is important that the provider’s practice management system manage the PLB segments correctly in order to get the information posted correctly without unnecessary manual intervention by the provider.”
All of our workgroups have special projects and activities underway, here’s just a brief highlight of a few:

  • The Remittance Advice and Payment Subworkgroup is pleased to announce that the first version of our paper on Best Practices for the Provider Adjustment Segment in the 835 has been published and is now available on the WEDI website. The SWG is now focusing on updating the paper with information on best practices for OverPayment Recovery. We began working on this topic at our face-to-face session, held May 20, 2019, at the WEDI Spring Conference in San Diego. We had excellent attendance – with a high percentage of first-time attendees. We had very good participation in the discussions and were able to make excellent progress on this next section of our paper.
  • The Genomics Workgroup will be hosting the webinar, Clearing a Path to Innovation in Clinical Genomics for Health Insurers on July 16th. This webinar will cover 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. This will include a discussion of priorities, like standardization and what does the insurer industry really need.
  • The Telehealth Workgroup hosted a session at the WEDI Spring Conference on telehealth and the opportunities it provides for caring for the aging population. The session was full, and we hope those who were there will join the Workgroup calls going forward. The Workgroup is continuing its initial drafting of the white paper on understanding the barriers to the broader adoption of telehealth. The paper will be presenting the results of the WEDI survey, further explaining the challenges, and offering ideas for how organizations can overcome them.
  • The Claims Subworkgroup met in-person at the WEDI Spring Conference, where participants brought up business issues they are experiencing related to claims. There was lively discussion about the CMS Appropriate Use Criteria Program. The Subworkgroup also presented the draft Understanding Encounters, Models, and Definitions white paper during a breakout session. A special thanks to the co-chairs and Carol Wanke of Sharp HealthCare for facilitating the discussion. The session was full and there was good discussion by the participants on the models that have been identified. The Subworkgroup will be incorporating the feedback it received into the paper. 
  • The Claim Status Subworkgroup met in person during the WEDI Spring Conference where participants brought up recommended changes that would make the transaction more valuable and also reduce the amount of phone calls needed to resolve claim issues. The Claim Status survey results were shared in a Wednesday afternoon session. Attend the next SWG call Friday, June 7 at noon ET to participate in the conversation.
The WEDI Member Spotlight gives members the opportunity to share their experiences and how they have benefited from WEDI membership. We recently talked with Ian Drysdale, President of Zelis ® Payments, where we asked about their organization, differentiators, the value of WEDI membership and emerging trends in the industry. Read this full Member Spotlight, as well as others, on the  WEDI website
Interested in finding out which other organizations value WEDI membership just as much as you do? View our full listing of WEDI Members here .
The Department of Health and Human Services (HHS) recently announced it 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 the industry turns to for information on using health IT to improve efficiencies in healthcare information exchange, praised the move in a 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. 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 ,” said President and CEO, Charles Stellar in the statement.
To read the full article, visit HITECH Answers . The WEDI webinar featuring CMS will be announced soon!
Rob Tennant describes how WEDI Conferences provide both education and networking opportunities for healthcare's leading stakeholders. Rob is a Board Member for WEDI and is also the Director, Health Information Technology Policy for MGMA.
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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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