HIPAA Electronic Remittance

HIPAA Electronic Remittance Project Case Study

Company: A Fortune 100 global bank in the USA

Healthcare Insurance Portability and Accountability Act of 1996 (HIPAA) compliant transaction sets. Bank required a solution for healthcare claims payment processing that enables providers to automate claims reimbursement and reduce administrative costs. For electronic transactions,
Healthcare Link should receive electronic transmissions or extraction of files from insurer sources. The data files should be customized, allowing payment information from paper and electronic sources to auto-post to practice management systems. The critical task of matching
data to payments should be done automatically. Healthcare Link should also provide a powerful content management toolkit, including a payment search engine, online reporting, integrated workflow and reconciliation support.

Solution: Keshav Consulting Solutions (KCS) was deeply involved with the bank to develop a healthcare link website which is highly flexible and secure so the providers can log in to healthcare link site and automate the claim reimbursement. To support the transition from paper
to electronic posting, paper payments and supporting materials are scanned at Banks Healthcare Centers of Excellence and converted to electronic files. To read these electronic files the bank has adopted different solutions.

Healthcare link website is built on the Microsoft .NET framework with technologies including but not limited to SQL Server 2005, service oriented architecture (SOA) and XML Web Services. The website has been built with four tier architecture model so as to make the system highly
secure. To migrate the data from electronic files the Bank has written some flexible windows services which automatically detect the files and loads the data into SQL Server database. This data is then displayed in the form of reports to the providers using the healthcare link website.

Benefits:
With Healthcare Link the providers were able to:
Auto-post transactions and accelerate cash availability

• Reduce reliance on paper
• Truncate paper and eliminate costs associated with storage
• Reduce salary expense associated with the claim-posting process
• Streamline customer service, research and inquiry resolution