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NEHEN Service GIF

NEHENEDI

Proven, Reliable Data Exchange

NEHEN’s X12 EDI services have been the backbone of healthcare data exchange in New England for over two decades. Trusted by both large and small healthcare organizations, NEHEN’s EDI platform ensures secure, efficient transactions for payers and providers alike.

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Overview

Designed for hospitals, payers, and providers, NEHEN’s X12 EDI services automate high-value transactions such as claims, eligibility verification, remittance advice, and referrals, reducing manual work and ensuring reduction in administrative burden for both payers and providers. Compliant with HIPAA, other regulatory mandates, and offering access to an extensive nation-wide network, NEHEN is a one-stop solution for your X12 EDI exchange needs.

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Transactions Supported

  • Eligibility & Benefits Verification (270/271): Instantaneous verification of patient insurance coverage and benefits.
  • Discovery Feature: Allows for a single benefit inquiry transaction which returns results from up to 12 payers in real-time.
  • Claims Submission (837): Simplified claims transactions for inpatient, outpatient, and professional services including online portal-based direct data entry.
  • Claim Status Inquiry (276/277): The real-time or batch submission of CSI inquiries for checking the status of submitted claims.
  • Remittance Advice (835): Standardized electronic remittance data for posting and reconciliation.
  • Authorization & Referrals (278): Streamlines the prior authorization process in real-time either as an integrated transaction or via our portal solution.

Why NEHENEDI ?

  • Established Trust: Serving over 250 healthcare organizations in New England.
  • Regulatory Compliance: Ensures alignment with federal and state-level healthcare regulations.
  • Cost Efficiency: Reduces administrative costs through automation and interoperability.

Specifications

  • Built on X12 5010 Standards: Ensuring maximum compliance and efficiency for all HIPAA-mandated transactions.
  • Custom Integration: Multiple options for integrating into the workflow including real-time integrated node connectivity, batch (file) submissions, online (portal) direct data entry and others. 

Vendor Partner

NEHEN’s X12 EDI platform is powered by Cognizant/TriZetto, providing the exchange platform along with expanded national network services

Unify and Simplify Health Information Exchange (HIE)

NEHEN offers a cornerstone HIE service for payer and provider trading partners wishing to exchange industry-standard X12, HIPAA-compliant transactions using real-time APIs or via an integrated portal or using batch processing. NEHEN will soon provide support for HL7 Fast Healthcare Interoperability Resources (FHIR) API data exchange for increased exchange of clinical and other data for a variety of use cases including prior authorization and quality measures.

Payers

Payers avoid clearinghouse costs by directly connecting with their exchange partners and working together to promote and implement common standards.


A Collaborative Community

  • Collaboration with healthcare leaders and technologists working on your behalf
  • NEHEN is a non-profit community of trading partners with a common goal of decreasing costs and improving healthcare

Advanced Claims Adjudication Features

  • Real time integrated eligibility inquiry and response
  • Submit a single real-time eligibility inquiry to multiple payers at once
  • Improved claims operations/reduced resubmission and duplication.
  • Greater adoption of electronic transactions, increased % of electronic submission
  • Reduced call center volume

Competitive, Customer-Friendly Fee Structure

  • No transaction fees
  • One fixed flat fee per month (paid quarterly) 
  • No long-term contracts
  • Free training and technical support

Ease Of Use

  • Access to technology used and refined for over 15 years
  • Opportunity to align organizational and exchange technology strategies with the community

Workflow Support

  • Simplified HIPAA and EDI testing
  • Fewer proprietary interfaces to support
  • Reduced total cost of operations

Participating Payers

Payer Grid rev 10-28-24In addition, Trizetto/Cognizant offers access to other payers across the United States via its expanded national network services.

Providers

Providers benefit from lower cost, higher value EDI services across an array of transactions including eligibility, discovery, claims, remittance, claim status inquiry, referrals, and authorizations. 


A Collaborative Community

  • Collaboration with healthcare leaders and technologists working on your behalf
  • NEHEN is a non-profit community of trading partners with a common goal of decreasing costs and improving healthcare

Extensive Regional and National Network

  • Unlimited access to NEHEN payers - no per-click charges!
  • Access to thousands of payer plans via the TriZetto Provider Solutions (TPS) network (a small transaction fee may apply for national payers, depending on the payer)
  • Medicare & Medicaid (MassHealth) included in NEHEN payer network

Competitive, Customer-Friendly Fee Structure

  • Flat membership-based fee includes all transactions and no per-transaction fees within the NEHEN payer network
  • Flexible terms to allow for changing business needs

Advanced Revenue Cycle Features

  • Automation tools and capabilities included/available such as claim denial analytics and automated actions
  • Our unique discovery feature allows for searching multiple payers (up to 12) with a single inquiry for any coverage or benefits

Ease of Use

  • No cost setup of real time (2 second) standardized eligibility inquiry and response integrated within the EHR
  • Single point of access for all transactions with online portal access self-administered by your organization
  • Discovery available via secure portal or batch transactions
  • Online onboarding of services including self-directed training for all staff

Workflow Support

  • Integration with all EHRs (Epic, Cerner, eCW, NextGen, Allscripts, etc.) using industry standard EDI transactions
  • Multiple modes of interaction including integrated real-time, batch via secure FTP, online via a secure portal

Participating Providers

Below is just a sample of the 200+ providers who trust and use NEHEN services:

  • Atrius Health
  • Beth Israel Deaconess Medical Center
  • Beth Israel Lahey Health
  • Boston Children's Hospital
  • Boston Medical Center
  • Mass General Hospital
  • Trinity Health New England
  • RiverBend Medical Group

 

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Interested in NEHEN for your Organization?

Find out how NEHEN can transform your data exchange process. Get a free estimate or a 30-day free trial account to learn more about how our X12 EDI services can benefit your organization:

 

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For Current NEHEN Members:

Technical Support: 

tps_nehensupport@cognizant.com

Member Services: 

781-907-7210

Urgent After Hours Support:

800-556-2231

Be prepared to provide your Site IDContact NameCall Back NumberReason For Emergency.