AoR+L1+-+Communities+of+Interest

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The Communities of Interest section identifies relevant stakeholders that are potentially affected by the content of the Use Case. This list may vary per Initiative, but the stakeholder definitions will be consistent throughout the S&I Framework (where appropriate), as defined by the Use Case Simplification Workgroup (examples included below). Click here to view the list of definitions: http://wiki.siframework.org/UC+Simplification+-+Stakeholder+Classification+SWG

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MAC- Medicare Administrative Contractors
 * || **Members of Communities of Interest** || **Working Definition** ||
 * **1** || **Individual Providers** || Healthcare providers with patient care responsibilities including physicians, advanced practice nurses, physician assistants, nurses, psychologists, emergency care providers, home health providers, definitive care providers, pharmacists and other personnel involved in patient care. ||
 * **2** || **Provider Organizations*** || Organizations that are engaged in or support the delivery of healthcare to include Hospitals, Ambulatory Centers, Provider Practices, Integrated Delivery Networks, and Rehabilitation Centers. ||
 * **3** || **Healthcare Administrators and Managers** || Healthcare administrators with patient information and medical records management responsibilities including Health Information Management (HIM) personnel, Registered Health Information Administrator (RHIA), Registered Health Information Technicians (RHIT), Inpatient/Outpatient Clinical Coding Specialists, Medical Transcription Specialists, Medical Records Safety and Security staff, Quality Control personnel, Physician Practice Managers, Pharmacy Benefit Managers, and other management personnel or entities involved in managing patient information. ||
 * **4** || **Payer Contractors** || Claims review programs and/or their specific implementation through associated contractors that are established to prevent improper payments before a claim is processed as well as identify any improper payments that can be recovered after a claim is paid. These programs include but are not limited to:

MRA –Medicare Recovery Auditor (formerly Recovery Audit Contractors, RAC)

PERM – Payment Error Rate Measurement Program

CERT –Comprehensive Error Rate Testing Program

ZPICS – Zone Program Integrity Contractors ||
 * **5** || **Payers*** || Any private or public entity that finances heath care delivery or organizes health financing. This includes commercial for-profit health insurers, non-profit health insurers, ERISA self-insured, state and federal department agencies that oversee Medicaid and Medicare health services delivery. ||
 * **6** || **EHR/EMR/PHR Vendors*** || Vendors which provide specific EHR/PHR solutions to clinicians such as software applications and software services. These suppliers may include developers, providers, resellers, operators, and others who may provide these or similar capabilities. ||
 * **7** || **Other Healthcare Vendors*** || Vendors that provide health care solutions other than EHR/EMR/PHR solutions such as software applications and services. Examples include: integration vendors, data providers, medical device vendors, RMMS (Remote Monitoring Management System) vendors, diagnostic imaging service provider, clinical order system supply vendor, transcription service vendors, clearinghouses, drug knowledge suppliers, network infrastructure provider, Clinical Decision Support (CDS) resource system, practice-based registry system suppliers, public health registry system, immunization information system providers, clinical genetic database/repository system vendor, practice management systems, and patient accounting systems, etc ||
 * **8** || **Patients*** || Members of the public who receive healthcare services from ambulatory, emergency department, physician’s office, and/or a public health agency/department. //While patient information is being exchanged as part of the eMDR, the patient is not a direct participant in this use case.// ||
 * **9** || **Certificate Authority*** || An organization that is responsible for the creation, issuance, revocation, and management of Certificates. The term applies equally to both Roots CAs and Subordinate CAs. ||
 * **10** || **Registration Authority*** || Any entity that is responsible for identification and authentication of subjects of certificates, but is not a CA, and hence does not sign or issue certificates. An RA may assist in the certificate application process or revocation process or both. ||
 * **11** || **Standards Organizations*** || Organizations whose purpose is to define, harmonize and integrate standards that will meet clinical and business needs for sharing information among organizations and systems ||
 * **12** || **Licensing and Certification Organizations*** || Organizations responsible for developing guidelines and ensuring that relevant parties adhere to those guidelines to ensure proper licensing and certification of systems and other health solutions related to healthcare. ||
 * **13** || **Operating Rule Authoring Entities** || As defined in Affordable Care Act Section 1104, such entities develop operating rules that define the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications. Rules developed under ACA Section 1104 may not necessarily apply to this Use Case. ||
 * **14** || **Beacon Communities*** || Selected communities of groups who have received federal funding through the ONC to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities to improve care coordination, increase the quality of care, and slow the growth of health care spending. ||
 * **15** || **Federal Agencies*** || Organizations within the federal government that deliver, regulate or provide funding for health and health care ||
 * **16** || **Agent – (Healthcare Clearinghouses and Business Associate as defined by Health Insurance Portability and Accountability Act (HIPAA) including Health Information Handlers)** || Any organization that handles health information on behalf of a provider as a covered entity or under a Business Associate Agreement (BAA) is an Agent. Many providers already use Agents to submit claims, provide electronic health record systems, etc. Organizations that are Agents include but are not limited to Healthcare Clearinghouses, Release of Information vendors, Health Information Exchanges, Electronic Health Record vendors, etc. ||
 * **17** || **Health Information Exchange (HIE)/ Health Information Organization (HIO)*** || __HIE/HIO__ - Health Information Exchange (HIE) is defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system ||
 * **18** || **Regional Extension Centers (REC)*** || Entities that support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs). RECs provide training and support services to assist doctors and other providers in adopting EHRs, offer information and guidance to help with EHR implementation, give technical assistance as needed. ||
 * **19** || **Health Information Service Providers (HISP)*** || Entities that serve as a node on the National Health & Information Network to enable a private, secure and safe alternative method to send and receive sensitive health information. ||

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