Helping Members Help Themselves
Beginning with this issue, Skyline News will feature a series of articles on activities that GNYHA is conducting to help its members address the many challenges facing the health care community today and going forward. The series begins with a look at Linxus, a GNYHA-managed consortium of health care providers and health plans that is committed to bringing standardized electronic information exchange to the health care community.

Linxus Providers and Health Plans Pledge to Collaborate on Electronic Information Exchange Standards
Consortium Aims to Simplify Reimbursement Process, Reduce Administrative Costs

Health plan and provider organizations participating in Linxus, a voluntary standards-setting consortium managed by GNYHA, announced recently that they have each signed a unanimous pledge to adopt single technology standards that will simplify reimbursement processes and make claims payment administration less costly. Linxus is a collaborative, consensus-driven organization of hospitals, physician groups, and commercial and government payers that is committed to increasing the standardization and use of electronic transactions and lowering health care administrative costs.

Working Together to Help Members: In their recent agreement, the health plans participating in Linxus made a commitment to be more consistent and specific in their electronic responses to providers using the transaction code sets provided under the Health Insurance Portability and Accountability Act (HIPAA). Providers agreed to support technology changes that will route electronic claim status, remittance, and eligibility responses specified by Linxus directly to appropriate staff, who will then be able to take action based on the data.         

Together, these shared commitments are expected to translate into fewer phone calls to check payment status and research payment denials, as well as give providers increased capability to automate the processing of routine claim payments.

Linxus health plan participants also pledged to establish free, over-the-Internet, direct connectivity methods for system-to-system electronic information exchange. Linxus expects this shared commitment to create further incentive for providers to increase the volume of their electronic communications because the Internet provides a lower-cost way to achieve connectivity than those offered currently by clearinghouses, which may charge fees to exchange information electronically over private "toll roads."

Linxus's provider participants consist of Montefiore Medical Center, Montefiore Faculty Practice, NYU Medical Center, NYU Faculty Group Practice, NewYork-Presbyterian Health System, Columbia University Practice Plan, Weill Cornell Physician Organization, Memorial Sloan Kettering Cancer Center, Memorial Sloan Kettering Practice Plan, North Shore-LIJ Health System, Continuum Health Partners, and The Mount Sinai Hospital. Health plan participants are WellPoint (Empire Blue Cross Blue Shield), Aetna, GHI, HIP, and Oxford Health Plans (a UnitedHealth Company). New York State Medicaid is an ex officio Linxus member.