Healthcare providers - Testimonials and Use Cases

• Assistance with Insurance Verification – Accurate insurance identification is critical to timely reimbursement and preventing denials. Many patients present a Medicare card when they are enrolled in a Medicare Advantage (Medicare Part C) plan administered by a private insurer. While original Medicare generally allows claims to be filed within one year of the date of service, Medicare Advantage and other commercial health plans often have significantly shorter filing requirements. Failure to identify the correct coverage at the time of service can result in claim denials and lost revenue because claims must be resubmitted, sometimes after a filing deadline has passed.
  
  Using TnHIE’s Clinical Viewer, authorized providers can access insurance and coverage information collected across participating healthcare organizations. TnHIE helps improve revenue cycle performance by supporting accurate billing workflows, reducing avoidable claim denials, and enabling providers to verify payer information, confirm current coverage, and identify Medicare Advantage enrollment before claims are submitted.
  
  
  
• Assistance with Prior Authorization – Obtaining prior authorization often requires providers to demonstrate that appropriate clinical evaluations, diagnostic testing, conservative treaments, and other evidence-based interventions have been completed before a procedure or service is approved. Gathering this information from multiple organizations can be time-consuming and may delay patient care.
  
  TnHIE helps streamline the prior authorization process by providing access to relevant clinical information including including encounter histoires, diagnostic results, medications, and other records contributed by participant healthcare organizations. Using the comprehensive information available through the Clinical Viewer, the adminstrative burden of collecting supporting documentation can be reduced and help providers meet payer requirements.
  
  The use of health information exchange aligns with federal interopearability initiatives that are designed to improve electronic access to clinical data, reduce provider burden, and support more efficient prior authorization processes.
  
  
  
• Prevention of Duplication of Services – Payers may limit reimbursement for certain services based on frequency, medical necessity, or coverage policies. When diagnostic tests, imaging studies, procedures, or other services have already been performed within a defined timeframe, a subsequent service may be denied as duplicative or not medically necessary.
  
  TNHIE helps providers identify relevant services performed across participant healthcare organizations before ordering additional tests or procedures. Authorized users can determine whether a patient has recently received a similar service and whether existing results may support ongoing care. This can help reduce unnecessary duplication, improve care coordination, support medical necessity documentation, and decresse the risk of claim denials.
  
  In addition to supporting reimbursement integrity, reducing unnecessary testing aligns with federal interoperatbilty and healthcare quality initiatives that focus on lowering costs, improving care efficiency, and ensuring providers have access to relevant clinical information at the point of care.
  
  
• Provider offices reduce staff time spent waiting for records and receive fewer faxed documents because the information is readily available in the Clinical Viewer.
  
  
• Tumor registries use the Clinical Viewer to collect longitudinal health information from a patient’s care team, helping ensure a more complete record of cancer diagnosis, treatment, and outcomes.
  
  
  

• Complete and timely access to patient information can help providers make more informed clinical decisions and accurately document the complexity of patient encounters. Using the Clinical Viewer, clinicians can review relevant medical history, prior diagnoses, medications, lab results, imaging reports, and other records from TnHIE participants. The additional clinical context can support appropriate Evaluation and Management (E/M) code selection.
  
  Accurate documentaion and coding help ensure that providers are reimbursed appropriately for the services delivered while supporting compliance with current CMS E/M coding guidelines. Access to more complete information can also reduce the need to obtain records manually, improving efficiency and care coordination.
  
  
• Accurate insurance verification is a critical step in the revenue cycle. Patients may experience changes in coverage, ronroll in Medicare Advantage plans, or maintain multiple active insurance policies, making it essential to confirm payer information before claims are submitted. Outdated or incorrect insurance information can lead to claim rejections, payment delays, and timely filing denials.
  
  TnHIE provides billing and revenue cycle staff with acess to insurance infomration collected by participaing healthcare provider organizations. By helping staff verify a patient’s current coverage and appropriate payer, we support the submission of clean claims, reduce administrative rework and improve the liklihood of timely reimbursement.
  
  
• Hospital Revenue Integrity Departments and Revenue Cycle teams are often required to obtain clinical documentation, supporting records, and other information needed to validate services, support medical necessity, respond to payer audits, and obtain reimbursement. Gathering records from multiple providers and care settings can be time consuming and may delay claims processing, appeals, and payment resolution.
  
  TnHIE provides access to clinical information contributed by participating organizations, including encounter records, discharge summaries, lab results, image reports, medication histories, and other relevant documents. This information is avialable through the Clinical Viewer, helping Revenue Integrity teams efficiently locate supporting documentation needed for claims submssion, denial managment, utilization review, payer audits, and reimbursement-related inquires.
  
  
• Provider offices can quickly determine whether a patient has undergone previous imaging or diagnostic testing, helping prevent duplication of services and supporting payer reimbursement guidelines.
  
  
• Many ICD-10-CM codes require documentation of multiple related conditions, such as diabetes with neuropathy or pregnancy-related complications. The Clinical Viewer provides coders with access to the clinical information needed to support accurate diagnosis code selection.
  
  
• Coding Assistance Examples
  
  
  • TnHIE provides the user with the ability to see previous ICD coding, which will assist in coding co-morbidities or determining if a patient has a chronic or acute condition.
  
  
  • Anesthesia Coding – TnHIE provides access to the patient’s medical history and current clinical information, which may support assignment of the appropriate ASA Physical Status Modifier (P1-P6).
  
  
  • E&M Coding – TnHIE provides access to prior studies, clinical history, and provider documentation that may support medical decision making and documentation requirements associated with Evaluation and Management (E/M) services.
    
    
  • Critical Care Coding – TnHIE can provide clinicians with timely access to relevant patient information that supports care coordination, clinical decision making, and documentation for critical care services.
    
    
  • Post-Procedural Coding – For services provided after surgery, such as physical therapy, TnHIE can provide access to operative reports and related clinical documentation that can support accurate ICD-10-CM coding and medical necessity documentation.
    
    

• Care coordinators use TnHIE to see a consolidated community-wide view of patient medical records to determine gaps in care.
  
  
• Care coordination departments receive daily reports providing information on their patients who had a hospital visit during the previous 24-hour period, enabling timely scheduling of follow up appointments.
  
  
• Medical record coordinators are able to find needed information in TnHIE which helps reduce the number of information requests made to other providers.
  
  

• Hospice/Home Health entities access patient demographic information, medications, and admits/discharges in the Clinical Viewer, which aid in providing in-home care. They also use the Clinical Viewer to find insurance information for billing services.
  
  
• Home Health entity receives alerts from TnHIE, notifying it of patient hospital events to assist with patient scheduling and in-home follow up.
  
  
• Long-term care entity is able to review cross-community medical data in the Clinical Viewer at the time a referral is received rather than when the patient arrives at the facility.
  
  
• Long-term care facility is able to receive patient care documents directly from the hospital using Direct secure messaging rather than waiting to receive faxes, which can delay patient intake.
  
  
• Long-term care facilities use the Clinicial Viewer to gather a more detailed, complete medical history on patients suffering from dementia and other diseases.
  
  

• Public Health entities receive daily reports from TnHIE to assist with Birth Defects and other public health tracking efforts.
  
  
• Public Health entities utilize the Clinical Viewer to gather communicable disease information and other information needed for public health tracking.
  
  
• Syndromic Surveillance information is electronically submitted to the TN Department of Health by TnHIE, reducing the manual data entry burden on the data source.
  
  
• Immunization data is electronically submitted to TennIIS by TnHIE, reducing the manual data entry burden on the data source.
  
  

• Direct Secure Messaging is used by medical providers to send referrals to specialists with clinical documentation attached to the message, reducing time spent faxing.
  
  
• Referral coordinators use the Clinical Viewer to view community-wide medical records of new referrals received by the practice prior to first appointment.
  
  
• Long-term care facility is able to receive patient care documents from hospital using Direct Secure Messaging rather than waiting to receive faxes, which can delay patient intake.
  
  

• Physician practices are able to quickly obtain lab reports and images performed at facilities and participating laboratories using the Clinical Viewer. Prior to Clinical Viewer access, the patient often had to be rescheduled because the practice could not get the results prior to the patient’s visit.
  
  
• In-patient addiction facilities are able to locate medical information of patients suffering from withdrawals using the Clinical Viewer, allowing appropriate medical care to be provided.
  
  
• Emergency Department personnel is able to view consolidated community-wide medical information from TnHIE inside their own EHR system by utilizing Single Sign-On (SSO). SSO eliminates the need for logging into the Clinical Viewer separately, saving precious time in emergencies. Crucial data from TnHIE is available inside the hospital EHR when patients are unable to respond or do not recall medication, allergy or other details.
  
  
• A rehab facility without an EHR system is able to send discharge summaries to TnHIE via Direct Secure Messaging in order to share data with other TnHIE participants.
  
  
• Rural physician offices are able to view patient reports from a specialist who treated the patient, supporting the referring physician in providing appropriate follow-up care.
  
  
• Behavioral health specialists are able to determine their patient’s medical conditions and medications prescribed by other care team members of the patient using the Clinical Viewer.  
  
  
• Pharmacies can see a patient’s medications in the Clinical Viewer and check for drug interactions and adverse effects after the patient is discharged from a hospital or other provider setting.
  
   
• Physician offices are able to review and study diagnostic test results performed at a hospital or another provider setting by using TnHIE’s Clinical Viewer prior to the patient’s office visit. This prevents rescheduling a patient’s office visit because the physician did not obtain the results in a timely fashion. 
  
  
• Hospital pre-admission testing (PAT) departments can identify and review the screening results performed inside their own EHR system because the hospital utilizes Single Sign-On (SSO) integration with TnHIE. Having this information helps eliminate test duplication, efficient surgical and in-patient service visits, and improve patient satisfaction.
  
  
• Rural physician offices are able to see patient records from multiple hospitals and providers using the Clinical Viewer. This especially assists when treating patients who are unsure about other providers or facilities they visited and treatments/tests potentially performed by other providers.

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