RWJF & HHS Provider Network Challenge Informational Webinar

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This informational webinar on the RWJF & HHS Provider Network Challenge gave more information on the challenge, associated data sources and Q&A.


  • RWJF & HHS Provider Network Challenge

    Robert Wood Johnson Foundation & U.S. Health &

    Human Services Provider Network Challenge

    Informational Webinar

    November 19, 2014

  • On Todays Call: Katherine Hempstead, Director of Coverage Robert Wood Johnson Foundation Richard Kronick, Director, Agency for Health Care Research & Quality U.S. Health & Human Services Reed Mollins, Vice President, Business Development John Riney, Technical Evangelist PokitDok Alicia Davis, Challenge Manger Health 2.0 Graeme Ossey, Senior Challenge Manager Health 2.0

  • Agenda for the Webinar Challenge Background and Goals Overview of the Data Set Overview of Challenge Details Additional Resources Q&A

  • Katherine Hempstead Director, Robert Wood Johnson Foundation

    Richard Kronick Director, Agency for Health Care Research & Quality

  • Focus of Challenge Allow consumers to determine which providers in

    their network are conveniently located Method of verification to determine if providers are

    accepting patients under each insurance Allow & crowd source patient reviews for providers Allow consumers to search for providers based on

    specific health needs and determine if insurance covers specific procedures.

  • What Are We Looking For? Effective integration of the Health Insurance Carrier

    Provider Network data Creativity and innovation Design, usability and intuitiveness of application Potential to help consumers understand provider networks

    and make informed decisions on choosing a provider Potential and realistic plans for adoption in the community

  • Criteria to Apply Business & nonprofit entities must be formed and

    maintain a principal place of business in the U.S. Individuals must be citizens or permanent residents of

    the U.S. Teams must have no more than 5 members Individuals must be of legal age of majority, at the

    time of entry, to form valid contracts I their respective jurisdiction of legal residence

  • Submission Requirements

    Phase I: A text description of the app or tool (no

    more than 1500 characters) including what data were used, how they were used, need, solution and business plan for dissemination and use

    Wireframes or similar design layout of the application

    Slide deck of no more than 10 slides describing the app and operating plan (in PDF format)

    The challenge will take place in two phases. Phase I will require teams to submit concepts and wireframes, while phase II will require working prototypes. The submission requirements for each phase can include (but not limited to):

    Phase II: All of the above A video pitch (no more than 5 minutes)

    describing the app/tool and how it would be used by the public to make better health plan purchasing decisions

    Link to working application

  • Prizes & Timeline Prizes

    Phase 1: Five (5) finalist will receive $5000 Phase 2: First Place: $50,000 Second Place: $15,000 Third Place: $10,000

    Timeline Challenge Launched September 22, 2014 Applications for Phase I will be due on March 6, 2015 Phase I Finalist Announcement : April 3, 2015 Applications for Phase II will be due on July 10, 2015 Phase II Winners Announced in August 2015

  • Q1 2014 Company Overview CONFIDENTIAL

  • 2Bringing Consumer Expertise to the Healthcare Enterprise

  • 3The Power of Results Ranking

    1. Eye-Tracking Analysis of User Behavior in WWW Search, Cornell University -- 2011

  • 4Implementation Example: Facility Profile Page

  • API Introduction for

    RWJF Provider Network Challenge Webinar

  • Hello!

    John Riney Technical Evangelist

  • API Overview With our platform, access simple X12 processing, our comprehensive provider listings, and proprietary cash pricing data for healthcare procedures. Our documentation guides you through testing the APIs from the command line & how to use our open-source client libraries for Python, Ruby, Java, C#, NodeJS, and PHP.

  • The Power of our Platform E-Commerce Marketplace APIs

    Providers Search for providers from one of the largest provider directories. Our directory provides biographical information, education, credentialing and other quality and business information. Use this API to let customers select providers based on a variety of factors.

    Cash Prices Based on our proprietary database, this API calculates the average cash price providers within a certain geographic area charge for a specific service. This is a good reference point for customers to use when selecting a provider for services or for selecting a geographic area to obtain those services.

    Insurance Prices Based on our proprietary database, the Insurance Prices API calculates the average price for a service that providers are submitting to insurance carrier within a specified area. This information can be used by customers to get an idea of how much they might save between a cash price or insurance price. It can also be used as a guide to select a geographic location for obtaining health care services.

  • X12 Claims & Eligibility Authorization API (ANSI 278) The Authorizations API allows an application to submit a request for the review of health care in order to obtain an authorization for that health care. This lets you determine if a given procedure or service is covered under a patients plan.

    Claims API (ANSI 835/837) Submits a Professional CMS 1500 claim to the specified insurance carrier. Please note, the Claims API only submits claims to an insurance carrier, it does not scrub claims. This API can be used to make sure a patients up front cash payment counts against their deductible.

    Claims Status API (ANSI 276/277) Checks with the insurance carrier what the status of a claim is. It has information on the outstanding claims for a patient, and what claims have been received, are being processed, or have been finalized. This is especially important for office billing managers who need a complete picture of where high dollar claims stand on a real time basis.

    Eligibility API (ANSI 270/271) Checks to see if your customer is a current and active member of specific health plan. Its currently available for 152 health plans, covering 71% of covered lives across the U.S. It provides information on what the customers deductible is and how much has been satisfied, helping to calculate a customers out-of-pocket expense for a healthcare transaction.

  • X12 Claims & Eligibility, Continued Enrollment API (ANSI 834) The Enrollment API allows the enrollment of new members into an insurance plan, updating of information, or changes the status of a members enrollment. An insurance broker or plan administrator would use this API to electronically enroll a customer or make benefit changes in the case of a life event.

    Plans API The Plans API can check a customers insurance carrier and see what their plan design is. This information is used in determining the benefits, copayments or coinsurance a patient has.

    Referrals API The Referrals resource allows an application to request approval for a referral to another health care provider.

    Trading Partners API This utility API lets you determine what trading partners we connect with and what transactions they support.

  • Getting Started

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  • Questions?

    Contact Alicia Davis at:

    RWJF & HHS Provider Network ChallengeOn Todays Call:Agenda for the WebinarKatherine HempsteadDirector, Robert Wood Johnson FoundationFocus of ChallengeWhat Are We Looking For? Criteria to ApplySubmission RequirementsPrizes & Timeline Questions?