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Servantis Helps Blue Cross and Blue Shield achieve Low-Cost Connectivity and HIPAA Compliance for 42 Health Plans.
Executive Summary
Servantis worked hand-in-hand with Blue Cross and Blue Shield to design and implement a scalable, HIPAA-compliant payer solution that manages the real-time flow of claims data across a nationwide network of more than 40 healthcare plans. We quickly deployed a senior-level team of leaders with proven backgrounds in financial services, telecommunications, medical payer environments, EDI processing and software development, leading to a successful, on-time implementation. Thanks to our strategic direction and technology expertise, the client was able to deliver a new generation of e-business services that benefit its plans, as well as their providers and consumers.
Business Issue
The client had a mission-critical objective
to implement a powerful, yet flexible technology solution that would
connect its family of independent healthcare plans, each with disparate
legacy systems, to a seamless e-business platform.
Within that context, our client faced the added
challenge of meeting the format, transaction management and validation
requirements established by the Health Insurance Portability and
Accountability Act of 1996. This sweeping legislation, known as
HIPAA, calls for healthcare entities to standardize administrative
processes and guarantee the security and privacy of consumer health
data. Because HIPAA touches all lines of the client’s business,
Servantis had to develop business processes, privacy practices,
security procedures and testing tools. Adding to the challenge,
our client needed to implement new infrastructure and support systems,
which required remote administration and maintenance of their entire
IT infrastructure.
Key Services
- Managed network services
- Integration, development and implementation
services
- Project management
and communications
- Testing community management
- HIPAA compliance
Strategic Approach
Servantis began the project by assessing the
client’s needs through a requirements and gap analysis. We
then developed business requirements and implementation plans driven
by the overarching goals of reliability, scalability, usability,
flexibility and support.
Servantis created extensive plans and templates
for the project scope, requirements and design. Our consultants
prioritized issues resolution and change requests from a business
value, risk and budget impact standpoint. The team also managed
the production connectivity, testing, certification, support and
maintenance of the new system.
To ensure interoperability among the health plans,
Servantis established operational standards, processes and service
level agreements. In addition, we provided the client with a comprehensive
suite of managed services that included automated systems monitoring,
network management, security, storage, web portal access and proactive
support services.
Throughout the project, we employed an incremental
approach to deliver results early and often, while simultaneously
mitigating risk. Servantis also focused heavily on ensuring maximum
system uptime, availability, scalability, reliability and security.
"We make long-term commitments
to our clients driven by a desire for them to succeed,” said
Jack Adams, president of Servantis. “By expanding our functional
knowledge of their business, we develop a deep understanding of
the issues and challenges they face.”
Cost-Saving Solution
Our senior-level team of leaders helped
create an innovative solution that established a framework to power
and automate transactions across 42 member plans in the United States
and Puerto Rico. This new system enhanced communication throughout
the network of plans, enabling real-time processing of HIPAA-compliant
transactions without the need to revamp legacy systems.
Deployed on time and within budget, the system
supports HIPAA-compliant transactions, including the 278,
270/271, 276/277 and 835 types. The technology also supports X12,
XML and customer-specific data formats, as well as various
system-level interfaces, including message queues and web
services. In addition, Servantis developed tools and graphical user
interfaces to facilitate system monitoring, problem diagnosis and
support.
The new system allows the client’s provider
community to access information in seconds, instead of the hours
or sometimes days required by its old methods. As a result, this
family of health insurers is already recognizing significant cost
savings, while providing improved service to its customer base.
Best of all, the system is fully compliant with HIPAA transactions
and code sets requirements.
“During this major enterprise integration
project, Servantis helped the client evaluate the overall effort
and capitalize on concurrent opportunities to reduce costs and improve
cash flow,” said Wade Parker, vice president of professional
services. “Thanks to our efforts, the client achieved the
short-term goal of HIPAA compliance, as well as the long-term
benefit of a competitive advantage in the marketplace.”
Meeting the Challenge of Geography
Because the client’s 40-plus payer
plans are located throughout the United States and Puerto Rico,
Servantis faced a significant geographic hurdle. We addressed the
mammoth scope of the project through frequent client interaction,
strict adherence to project management methodologies, effective
scheduling and extensive quality control efforts.
Despite the complex, distributed nature of the
implementation, Servantis was able to connect all 42 health plans
to the production environment over the period of a year. We successfully
met the project requirements and our delivery commitment, while
achieving significant improvements in reliability, scalability and
flexibility over old methods.
Innovations in Testing
To meet the complicated testing needs of the
client’s distributed environment, Servantis implemented a
24x7 web-based transaction testing portal that brought the network
of plans together in a collaborative environment for the first time
ever. This innovative solution automated the transaction validation
process, saving significant time and money. As each plan submitted
test transactions, the system tracked progress and used business
rules to move the plans along towards compliance.
Servantis consultants also facilitated and coordinated
all activities required to test transaction sending and receiving.
Each plan received a testing date, along with detailed instructional
materials to help guide technical staff through the process. Our
project leaders meticulously tracked progress as they monitored
the transactions flowing through the system. In addition, our team
of engineers developed specialized tools with graphical user interfaces
to help diagnose and resolve issues related to the sending and receiving
of transactions.
Technology
Servantis employed a range of technology solutions
to meet the client’s business objectives:
- Business process modeling
(BPM) that integrated with a software development model
- Custom-developed integration engine for
business rules processing interfaces
- Change management processes coordinated with
UML toolsets for version control
- Middleware integration of custom interfaces
that provided GUI administration
- Database development for trading partner agreement
interfaces to contract agreements
- Federal compliance
reporting web portals with audit trail reporting metrics for due
diligence
Is Servantis for You?
Servantis is a technology consulting firm
that delivers critical expertise in strategic planning, systems
integration, e-business solutions, software development and
managed services. As your technology solutions partner, we enable
the high-velocity change that is essential for success in
today's fast-moving healthcare and commercial sectors.
Our senior-level consultants have
an average of 15 years' experience in strategic IT and business
planning, project management, performance and regulatory compliance,
operations management, business process improvement, and technology
procurement and contracting.
For more information on how our technology
consulting expertise can bring value to your enterprise, please
contact us:
Servantis
401 N. Michigan Avenue
Suite 1200 Chicago, IL 60611
866.874.1100 (toll-free)
www.servantis.com
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