WISHIN to Launch Payer Access in January
WISHIN's Participant Advisory Board (PAB) and Board of Directors recently approved changes to the WISHIN Participation Agreement allowing health care payers to access the WISHIN Pulse Community Health Record (CHR) for four specified purposes.
Effective January 18, 2018, payers will be able to access clinical data through Pulse for: (1) claims adjudication; (2) prior authorization; (3) care management and (4) collection of quality data.
The new use case offers the opportunity to eliminate inefficiencies in the current process of payers requesting information and providers fulfilling those requests. "We know that there's still a tremendous amount of manual work on both sides of these transactions when it comes to requesting and receiving records," said Joe Kachelski, WISHIN CEO. "We can substantially change the equation by preempting many ad-hoc requests or 'chart chases.' This is a way for providers to realize additional value from their investment in WISHIN participation."
Payer contracts with providers routinely include provisions allowing payers to request clinical records from providers to the extent they are needed for the payer to carry out claims-payment activities and other functions. This is a pain point for payers and providers as both organizations typically devote multiple FTEs to process these requests through fax, secure email or postal mail.
In addition, as risk-sharing arrangements become more commonplace success will increasingly rely on effective and efficient data-sharing mechanisms between payers and providers. According to a recent survey conducted by Change Healthcare, 74 percent of payers are reallocating financial resources to build out new consumer engagement strategies and strengthen member relations in response to value-based models of care. Payers cited budget constraints, lack of interoperability with provider EHR/EMR systems and data sharing capabilities as major challenges to payers' abilities to meet the demands of these value-based models.
The new use case will eventually require payers to contribute data to WISHIN Pulse as well. WISHIN will soon convene a workgroup of payer and provider stakeholders to develop policies and technical specifications for payer data.
Payers' access to this clinical data will be a function of enrollment files submitted to WISHIN, which will determine the patients whose clinical data will be made available to them through Pulse.
New WISHIN Pulse Use Case Facilitates Prompt Ambulance/EMS Claim Filing
The WISHIN PAB and Board of Directors have also approved a new use case allowing ambulance and emergency-medical-services (EMS) providers to access specific clinical data available in WISHIN Pulse for billing purposes.
This change is in response to requests from ambulance and EMS providers, who are often not in a position at the time of transport to collect all the information necessary to bill for their services. They typically follow up days later to seek "face sheet" (encounter) information from the hospital to which they have transported a patient.
Ambulance and EMS providers often make multiple contacts with hospitals before they receive the face sheet from the encounter. This new use case relieves the hospitals of the burden of responding to these requests and allows ambulance and EMS organizations to more promptly bill for their services.
Health care payers, health care providers and ambulance/EMS providers with questions or who are interested in WISHIN Pulse services should contact WISHIN via email at
or by phone at (608) 274-1820.