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Electronic Claims Processing

July 20, 2011
by David Raths
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Virginia Health System is Among the First to Use the Nationwide Health Information Network to Expedite Disability Claim Requests
Michael Matthews
Michael Matthews

MedVirginia LLC, a provider-owned health information exchange (HIE) organization, has reached a milestone in its work with the Nationwide Health Information Network (NwHIN) and the Social Security Administration (SSA).

In late May, Centra, a three-hospital health system headquartered in Lynchburg, Va., went live in exchanging data with the SSA's MEGAHIT project to electronically process requests for medical information in order to expedite disability claim determinations.

MedVirginia used its HIE infrastructure and CONNECT gateway to the NwHIN to establish a link with Centra's McKesson clinical information system (based in San Francisco). “This leverages our clinical gateway to bring value to another hospital system, and it shows that the SSA connection process is repeatable and can be expanded to other communities,” says Michael Matthews, MedVirginia's CEO. “It needs to be a repeatable process and our goal is to cut the cycle time each time we do it,” he adds. “Using our existing gateway and having clinical policy issues worked through helps with efficiency gains.”

USING OUR EXISTING GATEWAY AND HAVING CLINICAL POLICY ISSUES WORKED THROUGH HELPS WITH EFFICIENCY GAINS. -MICHAEL MATTHEWS

SSA makes 15 million requests for medical evidence a year to 500,000 clinics, doctors, and hospitals. It spends $500 million per year gathering evidence on disability claims. The stimulus bill gave SSA $24 million in grant funding to add 10 to 20 more health information exchange partners via NwHIN.

MedVirginia became an early partner. In 2009 it became the first organization to connect to the NwHIN with the SSA project. Based on the success of that pilot, the SSA awarded contracts to 15 healthcare organizations in 2010, and the MedVirginia-Centra collaboration is among the first of those to connect in this phase.

Centra was already seeing benefits just a few weeks after going live, says Ben Clark, Centra vice president and CIO. “We have had 52 disability claims submitted, and in two cases the responses for approvals were almost immediate,” he adds. “That used to take 80 to 90 days typically. So the sooner those are approved, the better for patients, for providers, and for the health system.

Centra started on the project in March 2010 and went live in May 2011. The information exchange is based on the HITSP/C32 Continuity of Care Document (CCD) format. Clark notes that there were challenges “because CCD is not that good a standard yet. It was an effort to get all the data SSA was looking for in the format they required.”

Besides the administrative efficiencies gained, Centra also sees the project as a stepping stone toward Stage 2 meaningful use because it is now connected to the NwHIN, Clark says, and has some experience with which to approach other data-sharing efforts that the Centers for Medicare & Medicaid Services might propose.

Matthews says MedVirginia is talking to other health systems about working with SSA and is also interested in participating as Virginia moves toward developing a statewide HIE. Healthcare Informatics 2011 August;28(8):48

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