NEHEN, Harvard Pilgrim Health Care, Inc., and Informatics In Context (IIC) have entered into a pre-production pilot agreement to validate and transform NEHEN’s current medical prior authorization process to one that is real-time and fully automated. NEHEN is a consortium of regional payers and providers in New England with over 40 member organizations, which consist of over 55 hospitals, 8 health insurance plans, and tens of thousands of practitioners.

Harvard Pilgrim Health Care, Inc., (HPHC) along with a number of affiliated provider groups, are participating in a pre-production pilot program designed to validate the benefits of IIC’s real-time, automated Electronic Data Interchange (EDI) 278 prior authorization solution. Upon completion of the pilot and acceptance by HPHC, the project will move to production and the program expanded to encompass other NEHEN members.  The pilot program is slated to conclude at the end 2016.

IIC’s standards-based 278 Authorization Engine is able to achieve an extremely high level of touchless adjudication of all provider medical requests for prior authorization, by automating payer’s specific payment policies and clinical guidelines, including the business and clinical rules required for instantaneous, actionable responses. Requests for documentation, attachments, and/or questions are handled electronically using the EDI 275 daughter transaction.

Providers realize tangible benefits using a standards-based EDI 278 Prior Authorization (PA) submission process for payers using IIC’s authorization engine. Providers eliminate the need for manual PA processing, receive instant actionable responses, along with significantly reduced rate of denials.

“By adopting IIC’s real-time automated 278 authorization technology, NEHEN’s participating payers expect to realize significant reductions in operational costs, increased efficiency, improved response times, along with greatly improving our provider network experience” states David Delano, Executive Director of NEHEN.

“Partnering with NEHEN, a recognized technology leader in healthcare, will lead the health care industry to transition from the traditional manual model for handling prior authorization requests to one that is fully automated and standards-based electronic process, thereby improving resource efficiency, operational structure, and enabling support for meaningful analytics and innovation” according to Vikram Simha,
Founder/CEO of IIC.

“Fully automating the payer’s prior authorization process provides a new, more efficient model for collaboration between payers and providers, significantly reducing the effort and cost burden of decision making in advance of delivering care for both providers and payers.”


NEHEN is a regional, non-profit consortium of payers and providers who have designed and implemented a secure and innovative health information exchange for reducing administrative costs and improving the quality, safety, and efficiency of patient care.  NEHEN technology has changed the way administrative, clinical, exchange, and ePrescribing processes are performed in member organizations. The primary success factor for NEHEN has been the collaboration between health plans and providers.  The members of NEHEN believe that providing EDI (electronic data interchange) capabilities to their exchange partners represents an opportunity to improve administrative and clinical processes for the entire health care community. As a result, all intellectual property created for NEHEN is shared among the members. Collaboration has enabled the members to share costs, leverage experience gained by other participants, and accelerate the benefits of administrative simplification.
For more information contact: David Delano, Ph: (339) 222-4036