Virginia Health Exchange Network
The Virginia Healthcare Exchange Network (VHEN) is a collaboration of Virginia health plans and health systems dedicated to lowering administrative costs in healthcare convened by the Virginia Association of Health Plans (VAHP), The Virginia Hospital and Healthcare Association (VHHA), and the Governor’s Office of Health IT. VHEN is committed to a collaborative public-private model limiting unnecessary administrative costs in healthcare and speeding the adoption of tools and processes that can achieve that goal.
Charter
Whereas reduction in unnecessary administrative expenses can benefit healthcare payers, healthcare providers, and ultimately healthcare consumers; and Whereas there remain opportunities for healthcare payers and providers to apply transaction standards and online tools to reduce the cost of administrative transactions; andWhereas in the Commonwealth of Virginia there is interest among multiple stakeholders in making significant progress towards eliminating unnecessary healthcare administrative costs;
Pursuant to this charter, participating Virginia health care providers and health plans (the “Participants”) will undertake the following:
Purpose - Participants will engage in a time-bounded, metric-oriented, and coordinated effort to:
- Adopt and apply the so-called CAQH CORE Phase I operating rules to exchanges of eligibility transactions among Virginia payers and providers.
- Execute necessary contracts or business relationships with technology partner(s) selected by the group and participate in systems that address VHEN-defined priority areas including initially supporting a multi-payer web portal that;
- reduces providers conducting eligibility verification and claims submission via phone/fax for participating plans; and
- allows Virginia hospitals and providers to query the Medicaid eligible database (MMIS) and other payer’s eligibility systems to reduce the overall number of self-pay accounts.
- Evaluate additional approaches for reducing costs of collection, payment, and approvals, and where justified, engage in further defined, collaborative, and measured efforts to streamline healthcare administration in the Commonwealth of Virginia.
Scope - Cooperation under this chartered is focused on and limited to those activities mutually agreed to by participants which promote general adoption of online standardized healthcare administrative transactions, full compliance with applicable state and federal privacy provisions, and applications of those transactions to reduce healthcare administrative costs. In promoting online administrative data exchange, participants are also mindful of longer-term possibilities in other forms of medical exchange or telemedicine, and the need to consider these longer-term requirements, as near-term approaches are formulated.
Designation - Participants under the agreement will be collectively referred to as the Virginia Healthcare Exchange Network (VHEN).
Period - The term of the charter is from July 1, 2007 through June 30, 2012. The term may be extended upon agreement of Participants. A Participant may withdraw from participation upon written notice to the VHEN Steering Committee.
Performance - Participation under the agreement entails dedication of resources to the purpose of the agreement distinct from pre-existing business efforts.
Steering Committee - Participating organizations will be drawn from the private and public sector, from health plans and payers, and from hospitals and health systems. Participating organizations will nominate an individual to serve on the Steering Committee t hat will set goals, timelines and, where appropriate, budgets for initiatives undertaken by the group.
Superceding agreements - participants may elect to supercede this charter through formal incorporation or other amendments to the joint governance upon 2/3 vote of the participants.
VHEN Participants
Aetna
Amerigroup
Anthem
Bon Secours Health System
CareFirst
Carilion Health System
CIGNA
Coventry
HCA
Inova Health System
Kaiser Foundation Health Plan of the Mid-Atlantic States
Optima (Sentara)
Riverside Health System
Sentara Healthcare
UnitedHealthcare
University of Virginia Medical Center
VCU Health System/MCV Hospitals
Virginia Secretary of Technology
Virginia Department of Medical Assistance Services
Governor Kaine's News Release June 12, 2009
Legislation
