TEFCA Concepts
In order to connect to TEFCA, you need to go through an extensive vetting and onboarding process. Here are some important concepts to understand as you do that.
Principal listings always belong to Covered Entities
The right to retrieve data under the primary TEFCA Treatment Purpose of Use (POU) is limited to Covered Entities (CEs) who are Healthcare Providers. The vetting process confirms that CEs will be querying under a legitimate POU and then allows them to establish a Principal listing. All TEFCA queries must be conducted by or on behalf of a Principal listing. Business Associates cannot maintain Principal listings.
Business Associates act as Delegates
Business Associates (BAs) can conduct queries on behalf of CEs that they serve. The CE that owns the Principal listing must instruct their QHIN to add the BA as a Delegate that is allowed to make requests on their behalf, in a process known as "Delegation of Authority". Note: The BA Delegate can be connected to the network via a different QHIN.
If the CE is fulfilling all of its reciprocity requirements through the Principal listing and contributing no additional data via the Delegate listing, it can append the Delegation of Authority with an "Initiator-Only Attestation" confirming that the secondary listing has no additional data to contribute to the networks.
Vetting paths vary by type of Covered Entity
Path 1: Healthcare Providers that have in-person, physical patient interactions and participate in a government program (Medicare, Medicaid, Tricare)
- Type I evidence that you are both a Health Care Provider and Covered Entity (choose one of the following):
- Link to the Entrantβs listing in any directory maintained by the Centers for Medicare and Medicaid Services (CMS) (e.g., on data.cms.gov or medicare.gov)
- Link to the Entrantβs listing on any state government list of Medicaid providers
Path 2: Healthcare Providers that have in-person, physical patient interactions but only participate in commercial health plans
- Type II evidence that you are a Healthcare Provider
- Type II evidence that you are a Covered Entity
- Free text overview of the healthcare services you provide and expected query triggers
- Attestation that you interact with patients
Path 3: Healthcare Providers that only have virtual patient interactions
- Type II evidence that you are a Healthcare Provider
- Type II evidence that you are a Covered Entity
- Free text overview of the healthcare services you provide and expected query triggers
- Overview of how you interact with patients
Type II evidence
Evidence for Healthcare Provider (choose one)
- Documentation reasonably showing the Entrantβs receipt of payment from a payer within
the six months immediately preceding publication in the Entrant Review List
(Documentation should be redacted so that it does not include PHI, financial or any other
confidential information). - Link to the Entrantβs NPI listing in NPPES showing that the Entrant is the type of Health
Care Provider listed in the submission - Link to the Entrantβs listing on a state government website confirming it is licensed as the
type of Health Care Provider listed in the submission - Copy of a Certificate of Coverage for professional medical malpractice coverage
- Copy of or link to Entrantβs national accreditation as a health care provider (Joint
Commission, AAAHC, NCQA, URAC, etc.) - Link to the Entrantβs listing of its CLIA certification on S&C QCOR
- Link to the Entrantβs inclusion on a list of participating providers published by a payer
- Copy of a letter from a payer confirming that Entrant is a participating provider
Evidence for Covered Entity (choose one)
- Documentation reasonably showing the Entrantβs submission of claims to a payer or other
HIPAA standard transactions within the six months immediately preceding publication in
the Entrant Review List. (Documentation should be redacted so that it does not include
PHI, financial or any other confidential information.) - Link to the Entrantβs inclusion on a list of participating providers published by a payer
- Copy of a letter from a payer confirming that Entrant is a participating provider
Updated about 8 hours ago