Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.6.3. HIE to Support Eligibility and Authorizations

10/29/2013

HIE is also being used to send information to the state Medicaid program for eligibility determinations. Currently, all 98 nursing facilities in Utah use the HIEO, Utah Health Information Network (UHIN), to send an electronic request to obtain preauthorization for Medicaid coverage. This exchange provides a low-cost mechanism to securely send electronic documentation to the state to determine whether individuals meet Medicaid eligibility requirements. This exchange helps ensure timely service delivery and accurate information between the SNF and the Utah Medicaid program. An electronic preauthorization form is sent through secure e-mail, with attachments such as the scanned MDS, physical, and history; and eliminates copying and faxing, which the state no longer allows. The application prepopulates the form with provider information, as well as patient information such as name, birth date, and Medicaid number through state databases. The application requires diagnoses and includes a look up function for the ICD-9 diagnosis codes. UHIN is piloting this program with the HHAs.

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