WEDI Newsletter | October 2017
Executive Corner | The Faces of WEDI-Con | Webinar Update | Media Spotlight
WEDI On Demand: October’s Featured Video | 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.  
WEDI Workgroups Will Connect to Effect Change
at December’s WEDI-Con

Today’s healthcare landscape has become a tangled morass of requirements whose complexity makes it challenging for providers to reduce costs while ensuring necessary coverage and care for patients. The administration continues to struggle with how to change those requirements to improve areas that appear to be a burden for patients or providers, while not negatively impacting patient care, or eliminating administrative or clinical enhancements that are working and have improved the system.

As existing regulations, such as Certification of Compliance for Health Plans, continue to be re-evaluated, new rules are on the horizon. The long-awaited rule on attachments appears to be imminent, and prior authorization is becoming a major focus. As we look at possible implementation of new transactions, we also need continue to review and address barriers or obstacles that impede implementation and effective use of the mandated transactions that have already demonstrated benefits across administrative simplification and cost reduction.

Bringing together all the various stakeholders in the industry is key to addressing these obstacles and moving the needle of administrative simplification forward, as it is clear that providers and payers cannot effect change alone. Practice management system vendors must be involved to manage the administrative transactions, and marry that information with the needed clinical data moving forward. Clearinghouses and other vendors must expand beyond the traditional model of moving transactions to include new, varying data content and formats. We even need to bring our own perspectives as patients to the table to ensure that the ultimate goal – enhanced patient care – is kept at the forefront.

WEDI workgroups and subworkgroups bring together all these stakeholders to discuss new initiatives, education or best practices needed for overcoming barriers, and evaluation of ongoing industry changes to ensure all points of view are included. Participation in these groups brings more voices to the table, and ensures a more well-rounded outcome to our white papers, webinars, Policy Advisory Group (PAG) recommendations, and other initiatives.

WEDI participants can benefit by gathering information at sessions held at our periodic conferences and forums, such as the upcoming WEDI-Con this December in Reston, VA. This much-anticipated event will afford great opportunities for these workgroups and subworkgroups to meet face-to-face during onsite meetings so members can share insights and address challenges.

WEDI’s ultimate value lies in the participation of its members and the contributions that are made from all the differing points of view. Join us at the table and be a part of the conversation!

Pamela A. Grosze
Member, WEDI Board of Directors , Vice President,
Senior Product Manager, PNC Bank
In less than two months, WEDI-Con will bring together several industry thought leaders for insightful discussions focusing on some of the most pressing topics impacting our industry including prior authorization, HITRUST Assessments, Block Chain, the New Medicare Cards, electronic clinical quality (eCQM) and more.

Some of the faces you’ll see during the two day event include:
Don’t miss your chance to mingle with some of the industry’s most influential names at WEDI-Con! Register today!
Join us for two webinars on ERA Claim Adjustment Reason Code Mapping and Showcase of Cherokee Health System's Use of Telehealth! 

Monday, October 30th, 2017 at 11:00 AM - 12:00 PM EST

This webinar will describe the different types of adjustment reason and remark codes that are available to be used in the 5010 835, and the process used by a payer for mapping their internal or proprietary codes to the required standard codes. The webinar will also include, from a provider’s perspective, how to interpret / utilize in their workflow the codes received from various payers. It will also describe the sources for the codes and maintenance process, operating rules that impact use of the codes.  Register today!

Tuesday, October 1st, 2017 at 2:00 PM - 3:00 PM EST

This webinar will explore how Cherokee Health Systems (CHS) in Eastern Tennessee has been using telehealth for nearly 20 years to better serve the needs of their community by providing a broad range of telehealth services including psychiatric care, medication counseling, consultations in public schools, and crisis care. Telehealth is not simply a program CHS uses; it is a part of how they deliver services to best meet the needs of their patients. Hear Gregg Perry, MD, Director of Psychiatric Services; Andy Rhea, MBA, Chief Information Officer; and Jeffrey Howard, CPA, Chief Financial Officer talk about the lessons learned and successes of CHS’ use of telehealth. Register today!
WEDI: HIPAA compliance, payment recoupment concerns inhibit electronic payment adoption

HIPAA noncompliance among payers and concerns about overpayment recovery among providers are among the issues identified by a national health IT workgroup that has limited the adoption of electronic payments designed to streamline administrative tasks.
Greater collaboration between payers, providers and vendors to sort through those technical and administrative barriers would ensure more payment interactions are conducted electronically, according to a report  released   by the Workgroup for Electronic Data Interchange (WEDI), a health IT adviser for the Department of Health and Human Services.

To read the full article published in Fierce Healthcare, click here.
This month's highlighted Vimeo channel video features Mark Cone, Principal of N-Tegrity Solutions Group who describes the importance of risk assessments to healthcare stakeholders in our latest video A Deep Dive into Risk Assessments in Healthcare .
Visit the new WEDI Vimeo Channel to view our entire video library!
All of our workgroups have special projects and activities underway, here’s just a brief highlight of a few:

  • WEDI Property & Casualty Electronic Medical Bill (eBill) Subworkgroup State eBill Regulation Survey was distributed to state regulators on October 13. Thank you to those states who have completed the survey. We look forward to receiving the remainder of responses by the October 31, 2017 deadline. The survey is similar to related past surveys and will be used to update national information regarding state laws, administrative rules and related activities regarding electronic billing (“eBilling”) for medical bills submitted to Property & Casualty (Auto and Workers’ Compensation) insurance carriers.
  • The Payment Models Workgroup will be meeting on October 30, 2017 from 3:00-4:00 EST to discuss priorities for 2018. Among items that have the workgroup’s attention, we are expecting the final rule for MACRA 2018 to be released shortly; and, patient relationship codes are to be finalized by CMS by Nov. 1st. These items have economic and operational impact across the industry. Please join us to learn more!
  • The Remittance Advice and Payment Subworkgroup is holding a webinar on 10/30 on Claim Adjustment Reason Code Mapping. We are working on an Issue Brief on EFT Enrollment Security Best Practices, and will be meeting in person at WEDI-CON on Monday, December 4th.

Health Plans/Insurers


Technology Solutions/Vendors



HR Announcements

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
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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