TEFCA for Health Care Operations

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Operations

TEFCA for Health Care Operations

The Trusted Exchange Framework and Common Agreement (TEFCA) provides the groundwork for secure, nationwide data exchange for permitted exchange purposes.

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What’s the Health Care Operations exchange purpose under TEFCA?

The Health Care Operations exchange purpose includes administrative, financial, legal, and quality improvement functions of a covered entity (CE) essential to running its business and supporting treatment and payment activities. Under the Operations use case, qualified organizations can retrieve patient data to power the following workflows:
Underwriting
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Accurately evaluate and assess risks with comprehensive medical history for applicants. Streamline the underwriting process and offer an improved, more seamless experience.
Quality assessment & improvement activities
Leverage health data to evaluate and enhance healthcare quality, efficiency, and effectiveness, including performance measurement and outcomes improvement.
Medical review, legal, and auditing services
Use exchanged health information to review medical practices, assess compliance with legal standards, and conduct audits to ensure adherence to regulations and policies.

Is your organization ready for TEFCA and the CalHHS DxF?

As the nation’s only dual-designated QHIN and QHIO, Health Gorilla helps health care organizations comply with state mandates for data sharing, capture federal regulatory incentives, and share health information under permitted exchange purposes, including treatment.
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User’s Guide to the Trusted Exchange Framework and Common Agreement

Learn more about the goals of TEFCA, QHINs, permitted exchange purposes, and security and privacy requirements.

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Uses and Disclosures for Treatment, Payment, and Health Care Operations

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The HIPAA Privacy Rule at 45 CFR 164.501 defines the activities that fall under Treatment, Payment, and Health Care Operations.

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SOC 2 Type 2 is a stamp of approval on our controls relevant to data security, availability, processing, integrity, confidentiality, and privacy.

HIPAA

Complying with applicable health data laws, including HIPAA, is ingrained in our culture, processes, and staff training.

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