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Clearinghouse Offers HIEs Free Platform

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As the nation moves toward a national health information network, some claims clearinghouses have noted that such a national infrastructure--the electronic data interchange networks for routing claims and related transactions--already exists.

Now, clearinghouse vendor NaviNet is making an overt pitch for state- and regional-level health information exchanges and regional health information organizations to use its network--for free--to transmit clinical transactions.

The Cambridge, Mass.-based vendor has sent a letter to the governors of all 50 states offering to make its NaviNet Health Information Exchange network available at no cost. The company would generate revenue via transaction fees paid by HIE users. The platform also would be free to regional HIEs and RHIOs that are state-designated entities. "If I'm the state, I don't need to build the toll road," explains Kendra Obrist, chief marketing officer at NaviNet. "The toll road is in place."

Each letter explains the company, its scope of business in the state and an estimate of annual savings generated in the state by use of the NaviNet network. The letter to California Gov. Arnold Schwarzenegger, for instance, notes 67,637 providers in the state are NaviNet users and saved an estimated $45 million during the past year through the efficiencies of electronic communications.
"Yet, while the benefits of establishing health information exchanges are clear, so are the challenges. In the last 20 years, we have seen community health information networks and regional health information organizations fail due to expensive and complex technologies, lack of funding and poor adoption," the letter states. "By utilizing NaviNet at no cost, California has an immediate opportunity to improve healthcare services for all of your citizens, reduce cost and create a better, more efficient healthcare system."

There is little difference between NaviNet's HIE platform and its existing electronic data interchange network, Obrist acknowledges. "The difference is in how to use it, such as transmitting a discharge summary from a hospital to a primary care physician," she adds. Right now, the EDI network links providers and payers. What NaviNet is proposing is to also use the network to support peer-to-peer communication. 

NaviNet's EDI platform presently supports just a few categories of clinical transactions. These include:

  • Eligibility responses from participating insurers that identify gaps in care for the patient, such as being due for a hemoglobin test,
  • Transmitting data to or retrieving data from a payer-hosted personal health record, and
  • A blend of clinical and administrative data that make up certain existing transactions such as referrals and request for service authorizations.

NaviNet counts 770,000 providers, representing those in offices or hospitals that have contracted with the vendor for EDI services, as clients. These include physicians and other billable providers. Eighty-five percent of these providers are active users, meaning they have used the service in the past 30 days, Obrist says.

One requirement of economic stimulus funding for meaningful use of electronic health records is the exchange of patient data, Obrist notes. And clearinghouses are in position to make that possible in a cost-efficient manner, she contends. "Unless there's a solution available to every physician in the country, some will be left out of the opportunity to earn EHR dollars. We think we can play a role in filling that gap."

This article can also be found at HealthDataManagement.com.

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