HIPAA AUDIT SOLUTION

®SYBASE PROFESSIONAL SERVICESHIPAA AUDIT SOLUTIONUnderstanding thatChallenge—A major event has occurred in healthcare that has disrupted the traditional methods47 states have promptof claims processing and offered payer organizations an opportunity to reengineer their businesspay laws, this solutionprocesses. HIPAA standards have required payers to develop a new infrastructure to receive X12 enables payers to incor-porate business rules totransactions that contain HIPAA compliant claims. Business logic, state rules, and a CMS mandateaudit their claims andhave forced payers to go one step further to unbundle the X12 transactions and test individual claims identify settlementstatus, avoiding expo-for HIPAA compliance, rejecting only noncompliant claims and not the entire transaction. The nextsure to legal action.logical step in this claims processing evolution is the capability to audit and reconcile claims so thatsuccesses and failures can be tracked and documented to improve the process. This robust functional- With Sybase world classEDI technology, payersity will enable payers to speed up the adjudication process, which in turn will improve cash flow forcan send and receive alltheir provider networks, giving them a distinct competitive advantage. HIPAA transaction types.■ 270/271■ 276/277SOLUTION■ 278Sybase is proud to offer the HIPAA Audit Solution that will allow the healthcare industry to■ 820■finally realize the cost-saving benefits that drove ...