Open Access

A shared network should make each new connection easier to use, not create a new charge whenever another organization joins.

SHN includes the common connection software, required checks and testing, exchange, status and records for the use cases below. Additional operating and software services are optional.

Included — without SHN fees

The Open Access Transaction Catalog: seventeen included Transaction Types

Designated Open Access exchange carries no SHN participation, network-access, transaction or required Gateway-software-license fee — for the seventeen initial U.S. Transaction Types in the published Catalog (Network Rules, Exhibit B), within their defined scope and operating limits:

• Prior Authorization
• Patient Access
• Provider Access
• Payer-to-Payer
• Directed Treatment Exchange
• Public Health Reporting
• Eligibility, Benefits, and Cost Information
• Enrollment and Coverage Maintenance
• Claims and Encounter Transactions
• Claims Status
• Remittance and Payment-Information Exchange
• Appeals and Reconsiderations
• Referrals, Scheduling, and Care Transitions
• Orders, Fulfillment, and Results
• Prescribing and Medication-Benefit Exchange
• Attribution, Quality, and Health Program Exchange
• Secure Interpersonal and Organizational Communication

SHN calls this fee treatment Open Access; its protections are established in Exhibit A of the Network Rules. Each Transaction Type has its own supported specifications. Listing describes the fee designation, not a claim that every described capability is operational or that a Participant is qualified or activated to perform it. Delaware’s initial production work starts with prior authorization. The full Catalog, with scope and geography, is in the published Network Rules.

A working service, not just message transport

Network Exchange includes the required identity and connection checks, supported testing, requests and responses, required status, receipts, notices and basic error information. The required Gateway software is included.

The Network Console gives users a usable view of the records they may access, including standard search, filtering and export. Viewing required information across many connections does not turn it into a paid analytical service. SHN’s required support and correction of its own network failures are included too.

Optional services

Gateway Management. Run my digital front door. Managed Gateway — the operating arrangement under this category — covers deployment, maintenance, monitoring, support and recovery of the agreed Gateway configuration, with hosting where selected. SHN is responsible for the service it sells. You may instead operate the software yourself or use a qualified independent operator.

Enhanced Support. Help me run the Gateway I operate — additional assistance beyond the included support, while you or your appointed operator retain operation.

Network Management. Operate my external relationship estate — software and support for your organization’s own connection rules, reviews, change impact and follow-up work.

Network Intelligence. Produce an additional authorized result — analysis of information your organization is authorized to use, helping it understand repeated work and opportunities to improve.

Network Orchestration. Coordinate authorized shared work across parties toward an objective the individual underlying exchanges do not complete.

These are the five authorized service categories under the Network Rules. Managed Gateway has a defined service description and acceptance process; the other offers are made available as each is released, and every offer identifies what is included, supported configurations, availability, support and price before purchase. Buying management or analytical services does not require buying SHN Gateway operation.

Where the line falls

Suppose a provider’s required security credential expires. SHN updates its network status and supplies the required notice. That is included.

A plan may also have its own additional approval rules. Network Management can check which extra reviews are needed and send them to the plan’s team. The plan can do that work itself or buy it elsewhere. The rule check is already part of the purchased service; it does not require a second analytics purchase.

More reach, the same included rights

More participating organizations, recipients or required responses do not themselves create an SHN fee. You may decline every optional service.

No-fee exchange does not remove all implementation costs. Your systems, integration, infrastructure, vendors and selected operator may still have costs. A funded program covers the work it specifies.

A governed commitment, not introductory pricing

Open Access is established through the Network Rules and Fee Schedule. Changes to its designations follow the governing approval, notice and participant-protection procedures, and require Governance Council approval. Existing agreements and the applicable notice, participant and transition protections continue to apply.

Before live use, participants receive the scope, operating limits and responsibilities for their connection. Exceeding a limit does not authorize an unspecified bill. Ending an optional service does not erase included rights or required records; changing the Gateway operator involves an agreed handover.

New Transaction Types are added to the published Catalog with their own stated scope, geography and fee designation under the Network Rules. This page does not change an existing agreement or remove a right established under it.