WEDI Releases Industry White Paper, 'Understanding the Models and Definitions of Encounters'

October 21, 2019

WEDI, the nation’s leading nonprofit authority on the use of health IT to create efficiencies in health care information exchange and a statutory advisor to the U.S. Department of Health and Human Services (HHS), today announced the development of an industry white paper that provides a baseline understanding of various purposes of health care encounter transactions, their processing models and definitions.

According to the paper, “Health care encounter transactions have generally been thought of as secondary use of claims data; data that is used for research and public health surveillance. As alternative payment models and value-based care gain traction, health care encounter transactions and the use of that data have become more prevalent and meaningful. The industry needs to understand the current uses and transmissions of health care encounter data in order to address the barriers and variances that exist today.”

The 32-page document addresses the longstanding purposes, meanings, and needs related to the use and processes associated with health care encounter transactions. Some key takeaways from the white paper’s conclusion include:

  • The industry needs to understand the current uses and transmissions of health care encounter data in order to address the barriers and variances that exist today.
  • Encounter data is sent and received by different organizations. Although the entities involved in sending and receiving the encounter data and transmission methods are similar, each model has its own intent for why the data is being transmitted and what needs to be transmitted.
  • Various nonstandard and work-around methods are used today to send and receive data that are not accommodated in current standard transactions.

For more information on WEDI’s industry efforts surrounding Provider Adjustments, please visit the WEDI Claims Subworkgroup page.


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