PPA+UC+1+-+Communities+of+Interest

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= The content within this page has been incorporated into the PPA UC 1 - Provider Registration =


 * Communities of Interest** are public and private stakeholders that are directly involved in the business process or are involved in the development and use of interoperable implementation guides and implementation of the Solution. Some members are business actors. Communities of Interest may directly participate in the exchange, that is they are actors, or indirectly through the results of the improved business process.

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MAC- Medicare Administrative Contractors RAC-Recovery Audit Contractors (Soon to be MRA - Medicare Recovery Auditor) PERM – Payment Error Rate Measurement CERT –Comprehensive Error Rate Testing ZPICS – Zone Program Integrity Contractors ||
 * **Member of Communities of Interests** || **Working Definition** ||
 * 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. ||
 * 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, and other management personnel involved in managing patient information. ||
 * Provider Organizations || Organizations that are engaged in or support the delivery of healthcare. These organizations include but are not limited to Hospitals, Ambulatory Centers, Provider Practices, Integrated Delivery Networks, Preferred Provider Organizations, Health Maintenance Organizations, Health Systems, Academic Medical Centers, Long-Term Care Organizations, Rehabilitation Centers, and other organizations such as Durable Medical Equipment providers, Pharmacies, and Emergency Transport. ||
 * 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 for system interoperability. ||
 * Government Agencies || Organizations within the federal government that deliver, regulate or provide funding for health, healthcare, clinical, or biomedical research. ||
 * Healthcare Payers || Insurers, including Medicare, Medicaid, commercial insurance, Social Security Administration (disability), other health plans, self-insured employer plans, and third party administrators, providing healthcare benefits to enrolled members and reimbursing provider organizations ||
 * EHR/EMR / Financial System Vendors || Vendors which provide specific EHR/EMR / Financial System solutions to providers such as software applications and software services. These suppliers may include developers, providers, resellers, operators, and others who may provide these or similar capabilities. ||
 * Agent – (Clearing Houses and other entities as defined by HIPAA including Health Information Handlers) || Any organization that handles health information on behalf of a provider 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 Claim Clearinghouses, Release of Information vendors, Health Information Exchanges, Electronic Health Record vendors, etc. ||
 * Payer Contractors || Claims review programs that are established to prevent improper payments before a claim is processed as well as identify any improper payments that can be recouped after a claim is processed. These programs include but are not limited to:
 * Other System Vendors || Supply system for other intermediaries and Payer Contractors ||

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