Skip to main content

Excellus Blue Cross Blue Shield was pleased to host the 2018 National Plan Automation Group (NPAG) Conference in picturesque Lake Placid, NY. The event showcased 4 days of interactive sessions exploring opportunities in EDI, electronic payments, health records, “HEDIS,” and the past, present, and future of authorization transactions. While NPAG sponsored a progressive networking retreat, attendees took advantage of Lake Placid Golf Club, Ausable Chasm, and an adventurous BobSled Experience.

In case you were not able to attend, here’s our recap of what was discussed:

The Passion of the playmaker and the secrets of world class competitors. The NPAG opening keynote, David Holloway, the former NFL player motivated the audience to re-access their vision, write it down, and formulate a plan to make it happen. Holloway emphasized the importance of having a team with a “vision of greatness” to stimulate growth in the right direction. He also highlights the significance of having a valuable mentor – learning from an industry expert – while exploring your strengths and weaknesses.

Quality service is not a 9-5. Christopher Kidder, Excellus BCBS’ Profiling & HEIS Analysis Lead started off by stating “there is no off season for providing quality service.” The Accountable Cost and Quality Arrangement’s (ACQA) Improving Patient Health session provided a deep dive into a variety of topics, including technology and data, provider buy-in, collaboration, customer service, clinical engagement, and improving patient health. Kiddler, accompanied by the Provider Collaboration Initiatives panelists – Excellus BCBS’ Robert Coughlin and Patty Kenney and Regence’s Vicki Federico, discussed third-party data aggregates, integrating electronic medical records (EMR), and claims. Next, they went into detail about the importance of knowing your score, and how all reports are only as good as the frequency they are sent. It is recommended that sending data every 14 days or less would be ideal.

Kristin Swift began her session by asking “What is HEDIS?” The acronym is defined as healthcare, effectiveness, data & information, and set. This is the most widely used set of standardized performance measures in healthcare and is mostly known for its use in the commercial, Medicare, Medicaid, and Marketplace plans space.

Data Reporting: Data reflects events that occurred during the measurement year (calendar year). For HEDIS 2019, results are reported in June 2019. Swift described that desirable attributes of a HEDIS measure involve relevance, feasibility, and scientific soundness. “EMR records are being transferred and secured faster and faster and are making collecting data much easier as gateways advance” Swift says.

The past, present, and future of authorization transactions: “Fax, phone calls, and multiple portals are our biggest pain points when it comes to prior authorization” Toni Box alleged. In her presentation, she showed that the current state authorization transaction process is complex and time consuming. Regence completes an average of 3,700 prior authorizations monthly. 95% of these authorizations are submitted using fax, while the remaining 5% utilize a portal tool. Providers question the need and relevance of obtaining prior authorizations. The work is manual and creates an administrative burden to the provider.

Jeanine Smith and Box explored current and targeted initiatives and how they plan to simplify authorization creation. They outline how increasing the connections among hospitals, facilities, and physician practices could lead to a solution. We also learned about how Admissions, Discharge, and Transition of care (ADT) generates an increased number of auto-authorizations. Another essential initiative is continued infrastructure updates to land, parse, and provide data for downstream consumption. Box told us “a lot of the time, the member has no visibility in the prior authorization process until they are denied a service or prescription.” Because of this, outbound work to support bi-directional sharing of data is another future tactic they are looking to enforce. Overall, infrastructure upgrades need to happen to ensure centralized communication.

Thank you to everyone who visited Softheon Booth #1 to learn more about our leading EDI Gateway solution and our real-time EDI capabilities to support healthcare digital transformation and automation.


  1. David Holloway, former NFL player:
  2. ACQA’s Improving Patient Health, Robert Coughlin, Excellus BCBS:
  3. Kristin Swift, MHA. Manager, Policy Measures, 08/28/2018:
  4. Jeanine Smith, Senior Manager, Provider Connectivity Solutions and EDI Operations, Florida Blue. Toni Box, Assistant Director Provider Solutions at Regence, 08/29/2018: Link to presentation:


The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon, Inc. Please direct any questions or comments to

Leave a Reply