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National e-Claims (NeCST) Standards

National e-Claims (NeCST) Standards allow the electronic exchange of health financial data. NeCST standards provide the foundation for claims information exchange across the continuum of care and can support a wide range of health care providers in managing electronic claims. These providers include physicians, pharmacists, dentists, physiotherapists, optometrists, and chiropractors.

National e-Claims (NeCST) Standards                                          CDFU *

BUSINESS FUNCTIONS BENEFITS
  • Supports electronic claims management
  • NeCST Standards currently support invoicing; predetermination, special authorization and statements of financial activity in the pharmacy, physio-chiro and vision lines of business, through defined messages   
ACCESS
  • Increases access to patient claim information and status
  • Improves interoperability of systems and enhances patient-related health information exchange between health care providers
QUALITY
  • Increases consistency in data capture and reporting
  • Provides the foundation for claims information exchange throughout the pharmacy industry
  • Establishes and maintains patient medication history, and other relevant information, including patient self-selected and over-the-counter medications, patient substance intolerances and allergies
  • Enables consistent electronic billing and reporting, regardless of payor
  • Reduces manual submission of claims by patients since it can be done by their health care provider
  • Eliminates the need for patients to submit claims each time they receive health services
  • Allows providers to spend more time providing care and less time on administrative functions
PRODUCTIVITY
  • Decreases the time and cost associated with manual claims
  • Minimizes delays in claims payment
  • Enables the addition of unique patient demographic information, common across all health care systems and integral to each new prescription and new patient, to an EHR structure
  • Allows for demographic updates
  • Improves pharmacists and client communications because the adjudication response messages provide enhanced information to pharmacists
  • Allows continued reconciliation of payment received through a full suite of claims payment messages
MESSAGING & TERMINOLOGY INFORMATION
  • Messaging: HL7 V3.0
  • Terminology: HL7 Terminology Code Systems, SNOMED CT, ICD-10-CA, CCI

STANDARDS ACCESS

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Additional Resources

 

* Status Definitions

Canadian Draft for Use (CDFU) - The standard has been developed but it may or may not be implemented or be in use. The standard is considered ready to be used by early adopters: however, change is probable as stakeholders begin using the standard in implementations.

Canadian Approved Standards (CAS) - The standard is in use for the purpose(s) or context(s) for which it was intended. Only those parts of the standard that have been implemented or are in use can progress for consideration as CAS. This decision point signifies that the standard has reached a level of stability and is comprehensive enough such that major changes are not expected.

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Improving the quality of patient care through the effective sharing of clinical information among health care organizations, clinicians and their patients.



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