HL7 supplemental health data exchange
"HL7," or Health Level 7, is a format for exchanging patient health information to create patient registries. You can learn about HL7 at the www.hl7.org website, but here is some basic information that will help you understand data exchange arrangements with Priority Health so:
- Your PIP data appears in Patient Profile
- Your health measures qualifying for incentives are electronically credited to your practice
Required file format: HL7, version 2.3 or above
Transmission method: SFTP. Priority Health will be moving all SFTP transmissions to Michigan Health Connect in the future.
Eligible entities: Primary care provider systems, labs and other facilities, and vendors providing data collection on their behalf.
Data field titles and descriptions: Priority Health will map your field titles and descriptions to ours. You don't need to rename your fields or rewrite your descriptions.
HIPAA/business agreements: We don't need a signed business agreement for data exchange, since we have a contractual arrangement with the provider.
Data accepted: We can accept more data than is mapped. The "extra" data will not be used for our incentive/pay for performance programs and will not display in the online Patient Profile registry tool.
Important: Keep/capture the Priority Health member contract number in the file. This improves matching, as other demographics are less reliable/consistent.
- Once data exchange files are in production, data vendors are responsible for informing their clients about accepted data and any vendor data lapses and gaps (data not present in file, data not mapped/entered correctly, data not sent).
- All data submission questions and investigation should begin with the provider and their data vendor. If the data vendor is unable to resolve the questions, the data vendor should inquire with Priority Health.
File receipts/data validation: Priority Health provides file receipts of data validation reports periodically for clinical file arrangements, and as-needed for lab files.
Using HEDIS data
What data Priority Health maps, uses and displays is driven by the Healthcare Effectiveness Data and Information Set (HEDIS®) rules applied to our pay-for-performance program, Partners in Performance (PIP). Priority Health must follow these data rules because HEDIS® is a program of the National Committee on Quality Assurance (NCQA), the accreditation body used by Priority Health. HEDIS®:
- Prefers claims-driven data
- Recognizes the MCIR as a long-standing, state-wide and tested registry system for tracking immunizations
- Allows supplemental data only for some measures
- LOINC codes are preferred.
- The provider/facility may need to match/query your registration data to your lab data in order to recapture the payer information and member contract number. Some facilities segregate the registration data from the lab data, then re-match at the billing function. Providers have all the needed information, but sometimes not in the same application.
- If we have a contract with the facility/lab, electronic data exchange is covered within the TPO provisions of our agreement.
Registry/EHR/data warehouse (clinical) files
The mapping document you'll receive from us describes our criteria and explains what data Priority Health will use for our incentive program and other initiatives. Most of the mapped data will display in our online Patient Profile registry tool.
To get started
Email Mary Charbonneau, Provider Program Specialist, Network Innovation and Education at Priority Health, or call her at 248.324.2934. She will provide you with a step-by-step "road map" for setting up supplemental data exchange and our most current mapping document.