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101. Us Chs States-Role-In-Hie (pdf file)
     digital.ahrq.gov/sites/default/files/docs/medicaid/us_chs_states-role-in-hie.pdf
     September 25, 2006 - Network Model • Data access for multiple purposes • Quality data • Fewer errors • Quicker claims … processing • Automate transmission • Quicker claims processing • Better document delivery • … savings • Process efficiencies Stakeholder Interactions and Benefits • Faster HC delivery • View claims … Provide targeted funding Federal Agencies DHS CDC CMS Mandates & Funding Secure Network • View claims … fees for providers and per-claim transaction fees for payors • Originated by focusing on existing claims

102. C_RelevantLegalRequirementsforHealthDataExchange (pdf file)
     digital.ahrq.gov/sites/default/files/docs/page/C_RelevantLegalRequirementsforHealthDataExchange_1.pdf
     May 23, 2007 - While the main intent was to require health care organizations to conduct claims transactions using … HIPAA applies to all health plans, since health plans necessarily engage in claims transactions and … (either directly or indirectly, eg, by contracting with a claims processing vendor). … or receive claims payments—or engage in any other HIPAA- regulated claims transaction, such as checking … The hospital would therefore want the vendor to indemnify it against any such claims.

103. C_RelevantLegalRequirementsforHealthDataExchange (pdf file)
     digital.ahrq.gov/sites/default/files/docs/page/C_RelevantLegalRequirementsforHealthDataExchange_0.pdf
     May 23, 2007 - While the main intent was to require health care organizations to conduct claims transactions using … HIPAA applies to all health plans, since health plans necessarily engage in claims transactions and … (either directly or indirectly, eg, by contracting with a claims processing vendor). … or receive claims payments—or engage in any other HIPAA- regulated claims transaction, such as checking … The hospital would therefore want the vendor to indemnify it against any such claims.

104. Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
     digital.ahrq.gov/health-it-tools-and-resources/health-it-bibliography/quality-measurement-and-improvement/comparison
     April 26, 2021 - New development of standardized quality measures should shift from claims-based measures to clinically

105. The Role of Telehealth in COVID-19 Response - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/citation/r01hs028127-meeker-final-report-2023.pdf
     January 01, 2023 - Methods: The study was performed in a national telehealth service provider and administrative claims … Aim 2 - 52,843 encounters with COVID-19 related claims were identified. … Our second and third aims used claims data to model the healthcare systems’ primary and secondary response … Data Sources We used Optum administrative medical and pharmacy claims data for years 2018-2020 from … Aim 2 52,843 encounters with COVID-19 related claims were identified.

106. !Directions Fall 03 (pdf file)
     digital.ahrq.gov/sites/default/files/docs/workflowtoolkit/MGMA_IT_Assessment_Part_II.pdf
     June 01, 2003 - Do you have a procedure to evaluate the status of electronic claims processing for each of your payers … • Do you track the number of paper claims your group produces each month and routinely query payers … on their availability to accept electronic claims?

107. Utah Health Information Network Evaluation Method Summary (pdf file)
     digital.ahrq.gov/sites/default/files/docs/page/2006Root_052411comp.pdf
     May 26, 2011 - Utah Health Information Network Evaluation Method Summary uhin Utah Health Information Network Evaluation Method Summary AHRQ 2006 Jan Root, Ph.D. Assistant Executive Director uhin UHIN Pilot Submitter Receiver Message Format Hospital Providers (clinical messages) Payers (claim attachments) Discharge su…

108. HIE and Ambulatory Test Utilization - 2010 | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/hie-and-ambulatory-test-utilization/annual-summary/2010
     January 01, 2010 - However, there was an unanticipated sale of ManagedCare.com, the agency providing claims data for analysis … This allowed TransUnion/ManagedCare.com to send a claims dataset to QHN in late November for merging

109. Statewide Implementation of Electronic Health Records (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/uc1hs015397-bates-final-report-2008.pdf
     January 01, 2008 - Merging survey results with claims data enabled the evaluation of the relationship between EHRs and … An additional analysis examined the relationship between EHRs and malpractice claims. … Among EHR adopters, 5.7% of physicians identified as “high users” of EHR had paid malpractice claims … Electronic health records and malpractice claims in office practice. … Electronic health records and malpractice claims in office practice.

110. Health Information Exchange and Ambulatory Test Utilization - 2012 | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/hie-and-ambulatory-test-utilization/annual-summary/2012
     January 01, 2012 - ManagedCare was the agency providing the project with claims data for the analysis, and therefore new … Claims submitted by 306 providers in 69 practices for 34,818 patients from the second quarter of 2005

111. Harnessing Health IT for Self-Management and Medication Activation in a Medicaid Plan (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/r18hs017261-schillinger-final-report-2011.pdf
     January 01, 2011 - The second (ATSM-PLUS) also leveraged pharmacy claims to strengthen medication counseling. … Methods: SFHP used claims data to identify English, Spanish, or Chinese speaking members with diabetes … areas for prevention of medical errors, we linked automated telephone system inputs with medication claims … This is a very complex analysis requiring claims data from the SF Health Plan. … They report a 3-6 month lag time in obtaining claims, and then many claims get reversed, requiring data

112. Pilot Testing of Electronic Prescribing Standards | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/pilot-testing-electronic-prescribing-standards
     January 01, 2023 - changes in drug use patterns, possible medication errors, and hospitalizations based on medication claims … site visits; a survey of e-prescribing participants and non-participants; analyses of prescription claims

113. Compelled authorizations for disclosure of health records: magnitude and implications | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
     digital.ahrq.gov/health-it-tools-and-resources/health-it-bibliography/privacy-and-security/compelled-authorizations
     health records as a condition of employment, applying for various types of insurance, and submitting claims

114. Functional Characteristics of Commerical Ambulatory Electronic Prescribing Systems: A Field Study | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
     digital.ahrq.gov/health-it-tools-and-resources/health-it-bibliography/electronic-prescribing-erx/functional
     January 01, 2005 - Vendors' claims about their systems' capabilities had a 96% sensitivity and a 72% specificity when site

115. HIE and Ambulatory Test Utilization (pdf file)
     digital.ahrq.gov/sites/default/files/docs/activity/hie_and_ambulatory_test_utilization_2010_pdf__2.pdf
     January 01, 2010 - However, there was an unanticipated sale of ManagedCare.com, the agency providing claims data for analysis … This allowed TransUnion/ManagedCare.com to send a claims dataset to QHN in late November for merging

116. Prescribing Patterns of Cost-Effective Drugs (pdf file)
     digital.ahrq.gov/sites/default/files/docs/page/prescribing-patterns-of-cost-effective-drugs-quick-reference-guide.pdf
     April 01, 2009 - Source of Data for the Measure: Pharmacy claims or billing data. … Relative Cost: Low: if claims or pharmacy data are readily available.

117. Regulatory and policy barriers to effective clinical data exchange: lessons learned from MedsInfo-ED | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
     digital.ahrq.gov/health-it-tools-and-resources/health-it-bibliography/privacy-and-security/regulatory-and-policy
     MedsInfo-ED is a proof-of-concept clinical data exchange project that uses prescription claims data to

118. Barriers and Facilitators to Implementation and Adoption of EHR in Home Care - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/r21hs021008-sockolow-final-report-2014.pdf
     January 01, 2014 - The number of days required to process clinician documentation into final claims oscillated between … Considering that the number of staff who processed claims was fixed, the number of days to final claim … may have been impacted by increased or decreased volumes of claims to process. … Considering that the number of staff who process claims was fixed, the number of days to final claim … may have been impacted by increased or decreased volumes of claims to process.

119. Standardization and Automatic Extraction of Quality Measures in an Ambulatory EHR (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/r18hs017094-mccolm-final-report-2009.pdf
     January 01, 2009 - With the claims-coding method, providers can attach CPT codes to each patient encounter for a quality … measure population and submit those codes to CMS on claims for payment. … Successful reporting for the claims-coding method involves reporting at least 80% of the time on three … During this phase, CMH established and implemented a method to use the claims-coding method to report … This result is qualified by a low compliance rate for manual claims coding of the quality measures as

120. Statewide Implementation of Electronic Health Records | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/statewide-implementation-electronic-health-records
     January 01, 2023 - /Electronic Medical Record The relationship between electronic health records and malpractice claims … The relationship between electronic health records and malpractice claims. … Electronic Health Record/Electronic Medical Record Electronic health records and malpractice claims … Electronic health records and malpractice claims in office practice.