Since 1993 Utah law has required the Utah Insurance Department (UID) to adopt health information exchange and billing standards by administrative rule for the Utah health care community. The Utah Department of Health (UDOH) created a similar rule in 2011 for the exchange of clinical documents. Both UID and DOH have selected the UHIN Standards Committee to act on their behalf to convene healthcare community stakeholders (payers, providers and government) for the specific purpose of developing the standards that are placed into their respective rules.
Utah standards are created to address the data/billing needs of healthcare community stakeholders. These standards are based on national standards such as the ASC X12 Claim and Eligibility transaction standards. UHIN develops standards at the state level, but is also an active member of the national standards organization and participates with the development of the national exchange standards. UHIN’s involvement allows Utah’s community stakeholders to have a voice at both the local and national levels.
The process for creating a Utah standard begins with a community need, or in response to a mandate from the State or Federal governments. The need or issue can be brought to the UHIN Standards Committee for discussion at the monthly meeting, or it can be reported via phone and email to UHIN’s Customer Service (877-693-3071 or firstname.lastname@example.org), where the item will be placed on the agenda for discussion.
A Real Example:
Applied Behavior Analysts brought attention to a newly-enacted Utah rule that required payers to cover services to autistic children. As this was a new benefit, the billing differed from payer to payer.
These providers wanted to standardize the billing to reduce unnecessary administrative costs and to provide seamless billing from payer to payer in coordination of benefits situations.
The Standards Committee chartered a subcommittee, which created and sent the new standard to the UID for inclusion into the rule. In addition to providing the standard for acceptance into rule, it has been forwarded to national entities such as the American Medical Association for consideration as they create national standard procedure codes for billing.
Developing a Standard
The process begins with identifying a need and presenting that need to the UHIN Standards Committee.
- A discussion of that need is held at the Standards Committee monthly meeting. The discussion can result in either a plan of action, or the formation of a subcommittee to develop a standard to address the issue.
- If a subcommittee is formed, participants will meet with the intention of creating a standard. All community stakeholders are invited to participate in the standard development process. Once complete, the newly developed standard is taken to the Standards Committee for review and acceptance.
- When the subcommittee presents the new standard to the Standards Committee, the document will be reviewed and discussed. If there are no outstanding issues with the standard, it will be placed on the agenda of the next Standards Committee meeting for a formal vote.
- During the following Standards meeting, a vote will be taken to accept the standard and to move it forward for approval by the UHIN Board of Directors.
- Once the standard has final Board approval, it will be placed on the list of standards that will be provided to either UID or UDOH for inclusion into the state rule. The list is forwarded once yearly to the state.
This completes the UHIN Standard Process. After the UHIN process is complete the State begins its process for adopting the new or revised standard into the state rule.
- The standard is received by the appropriate Department.
- The commissioner will open the rule and make a “proposal to rule making.”
- The revised rule will be published and a public comment period will begin. The department will respond to any comments received during the comment period or hold a hearing if necessary.
- Once all comments have been addressed and resolved, the standard will be adopted and become part of the final rule.
 The UHIN Board of Directors meets quarterly.
 It is common for the comment period to last 30 days.