WEDI Releases Two Key Industry White Papers Focused on Issues Impacting Current Health Care Climate

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Advisor to HHS releases latest industry resources that offer health systems guidance on navigating incorrectly routed payments; value-based payment models

“Incorrectly Routed Payments And Remittance Advice” offers guidance for payers and providers on situations that occur when electronic healthcare claim payments and/or remittance advice are routed to a receiver incorrectly, potential causes, and best practices to remedy the situation.

WEDI, the nation’s leading nonprofit authority on the use of health IT to create efficiencies in health care information exchange and a statutory advisor to the U.S. Department of Health and Human Services (HHS), today announced the release of two industry white papers, each focusing on key issues impacting the current health care climate – Incorrectly Routed Payments and Remittance Advice and Value Based Payment Models.

Authored by the WEDI Remittance Advice and Payment Subworkgroup, “Incorrectly Routed Payments And Remittance Advice” offers guidance for payers and providers on situations that occur when electronic healthcare claim payments and/or remittance advice are routed to a receiver incorrectly, potential causes, and best practices to remedy the situation.

According to the paper’s conclusion: “Manual user errors at the payer, claim matching issues where the claim is matched at the payer to the incorrect provider, or enrollment/setup issues at the payer, may cause a claim payment or electronic remittance advice to be directed to the incorrect provider. This has significant impact to both the provider and payer. To prevent this from occurring, payers should include system validation that the HIPAA-Standard National Provider Identifier (NPI) and/or the Taxpayer Identification Number (TIN) selected for payment coincide with the provider or payee organizational relationship and are associated correctly within their registration system.”

In addition, the WEDI Payment Models Workgroup released the first in an on-going “Did You Know?” series with “Volume One – ‘Value Based’ Payment Models.” The 16-page document addresses a variety of topics, including:

  • What is the difference between value-based care and value-based purchasing or value-based payment?
  • Why is value-based payment trending accelerating? Why must the economic model change?
  • Is there an industry standard framework to gauge value-based payment characteristics and common models?
  • Does interoperability play into value-based payment?
  • What are “shared savings” and “bundled payments” examples of value-based payment models?

For more information on WEDI’s industry efforts, please visit Workgroup Community page.

About WEDI

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 reduce costs of our nation’s healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit http://www.wedi.org and connect with us on Twitter and LinkedIn.
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Tom Testa
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