NeCST standard to bring cohesion to e-claims process

Canada Health Infoway has invested $1.1 million in the last phase of a project aiming to provide a single, open-source standard for exchanging financial claim information among health-care organizations.

The national

e-Claims Standard (NeCST) messaging project is a collaboration between the public and private sectors as well as national health provider associations over the last five years.

“”There were all sorts of e-claims, or electronic-based claims systems, across Canada, explained Grant Gillis, manager of standards liasion at the Canadian Institute for Health Information (CIHI) in Toronto, a sponsor of the project.

“”Usually each profession and or each insurer would have to develop from scratch their own software to support their e-claims transactions. This resulted in a lot of overhead and a lot of redundancy. It also meant that a lot of the information could not be shared.””

NeCST allows insurers to use a globally well-recognized standard — Health Level Seven or HL7 — to share messages, or transactions, more easily while working on claims settlements, Gillis said.

He said the messaging standard also permits insurers to work in a “”much more effective manner”” with hospitals and clinics because many use HL7 messaging. He added it results in a faster payment of claims.

On a wider scale, NeCST plays a role in sharing lessons about messaging needs with developers of other electronic health record initiatives across Canada, said Gillis.

As well, he said, the project has garnered a spirit of trust and partnership by bringing together health-care insurers and clinical associations. “”The process itself has been a value-add for Canada.””

So far, said Gillis, NeCST has developed the software code for 40 electronic messages, and will complete the process by the end of March. Many of the physicians groups are ready to standardize on HL7.

Early adopters include BCE Emergis and the Workers Compensation Board of Ontario, which last September began exchanging electronic claim information regarding patient visits to chiropractors and physiotherapists, said Sharon Moore, director of standards at Canada Health Infoway in Toronto.

Moore added that the Opticians Association of Canada last March partnered with Continovation Services Inc. to supply electronic claims to opticians in Alberta. The idea is to eventually incorporate the system into the NeCST standard.

Although some insurers and health-care providers have readily embraced the technology, Moore admitted there were some hurdles along the way.

“”I would say one of the barriers, from my perspective, is just on the providers’ side — really them embracing technology,”” as opposed to being content with the status quo of paper-based submissions, she explained.

She noted other Canada Health Infoway projects have shown physicians and other health-care providers need to make more of an effort to accept technology.

The other obstacle is switching dentists and pharmacists, who have already developed a pan-Canadian standard to submit electronic claims, to the NeCST system.

“”There needs to be a business case, a reason to move and that sort of thing. I would see pharmacy and potentially dentists as just taking longer, I guess, to migrate.””

Among the organizations involved in NeCST include the Association of Workers Compensation Boards, Alberta and B.C. Ministries of Health, Canadian Dental Association, National Blue Cross associations and Interassure.

Canada Health Infoway’s investments in NeCST have averaged about $3 million, but Moore said other participants contribute equally or more to the project through financial contributions, human resource time and travel costs.

Canada Health Infoway’s NeSCT investment also coincided with its $300,000 funding for standards projects involving telehealth and teleradiology.

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