Mettle Solutions primarily focuses on areas that pose a challenge to providers and payers in the health IT industry. Mettle participates in many of the HL7 Da Vinci workgroups where these challenges are being addressed with specific use cases, fostering discussions between industry experts and representations from all major stakeholders. This open collaboration and active engagement on standards development provide consensus for the resultant HL7 Fast Healthcare Interoperability Resources (FHIR) standards and implementation guides.

Mettle Solutions’ area of expertise is in implementing FHIR standards. Mettle has proven experience in rapidly moving from pilot phases to production environments. Mettle develops innovative standards-based Health Information Technology (HIT) solutions that are secure, reliable, and robust. The solutions are offered either via services on a secure cloud or custom-built for clients’ needs leveraging our pre-existing modules; both approaches aimed at minimizing time and cost.

Payer Transition Information Exchange (PTIE)

As part of the recent ‘CMS Interoperability and Patient Access’ Final Rule, specific payer-to-payer data exchange is required to be implemented by all CMS-regulated payers. Mettle Solutions has developed two variant solutions, PTIE and PTIE+, for payers to securely exchange patient clinical data while a patient is transitioning from one payer to another.

PTIE provides basic and CMS-mandated features. PTIE+ is an extended solution with additional value-added services. The PTIE solutions have been developed in compliance with the related standards developed by the HL7 Da Vinci project using FHIR:

  • Payer Data Exchange (PDex)

  • Payer Coverage Decision Exchange (PCDE)

The key value-drivers for PTIE solutions include support in gathering a cumulative patient health record from the previous payer; facilitate informed decision making by the new payer; increase efficient care, and better health outcomes; reduce duplicative tests and services; reduce provider burden eliminating duplication of medical necessity documentation; empower patient with complete information on which to base healthcare decisions.

 

Medical electronic Prior Authorization (MePA)

Clinicians have identified documentation requirements for items and services associated with prior authorization as significant sources of burden (source: ONC’s burden report). Mettle Solutions has been continuously contributing to the healthcare industry's efforts to leverage and implement newer technologies that significantly improve the prior authorization process for medical services. The basic MePA solution supporting all the necessary prior authorization functions, along with MePA+ extended solution with additional value-added services, has been developed as all-payer solutions. The solutions support prior authorization exchanges (requests/responses) in compliance with the related standards developed by the HL7 Da Vinci project using FHIR:

  • Prior Authorization Support

  • Coverage Requirements Discovery (CRD)

  • Documentation Templates and Coverage Rules (DTR)

The MePA solutions include the translation support for being compliant with the HIPAA mandated X12N 278 transactions for prior authorization services. Both MePA solutions offer EHR integration supporting pre-fill data for PA requests, if applicable, or alternatives supporting a single application for all the payers with the primary goal of reducing provider burden. MePA+ extended solution includes customization for payer-specific coverage and documentation requirements lookup services, status tracking, and computer-assisted prior authorization responses, as applicable.

 

electronic Medical Documentation Exchange (eMDx)

Mettle Solutions has been championing the Center for Medicare & Medicaid’s (CMS’) program integrity efforts to lower costs and reduce improper payments in the Medicare Fee-For-Service (FFS) program for years. Leveraging the experience and role as a trusted industry partner to CMS in supporting the related Electronic Submission of Medical Documentation (esMD) program, Mettle has developed the eMDx solutions. The basic eMDx solution supports the payer sending electronic Medical Documentation Requests to providers and receiving the responses with the electronic medical documentation. The extended eMDx+ solution includes additional value-added services such as the payer supporting documentation requirements lookup services and support for providers exchanging documentation with other providers. The eMDx solutions have been developed for exchanging electronic health information in compliance with the related standards developed by the HL7 Da Vinci project using FHIR:

  • Clinical Data Exchange (CDex)

  • Coverage Requirements Discovery (CRD)

  • Documentation Templates and Coverage Rules (DTR)

The extended eMDX+ solution also uses HL7 FHIR implementation guides for Post-Acute Order and Durable Medical Equipment (DME) Order. Both the eMDx solutions offer EHR integration supporting pre-fill data if applicable from EHR directly.

 

Quality Measures on FHIR (QMF)

Mettle Solutions has upgraded its Quality Measures product suite and solutions with newer technologies including HL7 CQL and FHIR. The QMF solutions include the measure definitions updated using CQL, an updated measure calculation engine, and measure reporting modules using FHIR. To succeed in quality measure reporting for value-based care, it is imperative to focus on addressing gaps in care efficiently and promptly. Anticipating or closing gaps in care, at point of care, is an opportunity to improve care quality and cost of care. 

The QMF solutions offer EHR integration supporting pre-fill data as applicable from the EHR directly and provide updated tools and utilities supporting gaps in care, at the point of care.  The QMF solutions have been developed in compliance with the related standards developed by the HL7 Da Vinci project using FHIR:

  • Data Exchange for Quality Measures (DEQM)

  • Gaps in Care and Information

Documentation Requirements Lookup Service (DRLS)

Mettle Solutions has been continuously working to build a universal framework to facilitate a single lookup service that enables a provider to access any participating payer’s documentation, coverage, and authorization requirements. The DRLS solutions include EHR and practice management integration at the point of care to check with the respective payer on the requirements and to determine which documentation templates and rules need to be used. Provider access to the requirements and rules, at the point of care, will reduce provider burden and also help payers reduce improper payments due to insufficient documentation to support a claim. Including the DRLS solution in the prior authorization process will help to streamline the process, improving efficiency and the outcome. The DRLS solutions have been developed in compliance with the related standards developed by the HL7 Da Vinci project using FHIR:

  • Coverage Requirements Discovery (CRD)

  • Documentation Templates and Coverage Rules (DTR)

 
 

Provider to Provider to Exchange (P2PE)

Interoperability between HIEs, EHRs, and several other software vendor packages has been one of the biggest challenges faced by a various post-acute care provider in settings such as LTCHs, SNFs, HHAs, IRFs, and Hospice. Mettle Solutions has been developing HL7 FHIR standards-based P2PE solutions to close the gaps in the care coordination across the continuum. Recent updates to the P2PE solutions include development following the implementation guides of HL7 FHIR standards: 

  • Post-Acute Order and Durable Medical Equipment (DME) Order

The ordering provider should send required coverage supporting documentation as applicable to the rendering or supplying provider in the case of prior authorization or a claim review response. The P2PE solution, in the case of PAC services, aims to avoid delays in exchange and duplication of information collection, resulting in decreased administrative costs and burden and increase to the quality of care. The P2PE solution will also reduce those costs, burdens, and quality outcome concerns related to preventable adverse events and readmissions caused by delays of an inefficient process of information exchange.  The majority of improper payments made by payers include insufficient documentation from providers which could also be minimized with P2PE solution.

 

Computer-Assisted Review Tool (CART)

Mettle Solutions has developed documentation and information review solutions for payers, leveraging the newer technologies (FHIR resources) and providing semi-automated reviews, as needed and applicable, with computer assistance tools. The CART solution includes support for reviews of Structured and Unstructured documentation including deterministic reviews applying the payer rules and utilizing artificial intelligence results, as applicable, in guiding the reviewers. The CART solution allows workflow configuration and user management to be customized according to the client’s needs.

 

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