HIPAA AUDIT SOLUTION

Epsu - Kristina Reese

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English

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®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 ...

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Publié par	Epsu
Nombre de lectures	10
Langue	English

Extrait

® S Y B A S EP R O F E S S I O N A LS E R V I C E S H I PA AA U D I TS O L U T I O N

Challenge—A major event has occurred in healthcare that has disrupted the traditional methods of claims processing and offered payer organizations an opportunity to reengineer their business processes. HIPAA standards have required payers to develop a new infrastructure to receive X12 transactions that contain HIPAA compliant claims. Business logic, state rules, and a CMS mandate have forced payers to go one step further to unbundle the X12 transactions and test individual claims for HIPAA compliance, rejecting only noncompliant claims and not the entire transaction. The next logical step in this claims processing evolution is the capability to audit and reconcile claims so that successes and failures can be tracked and documented to improve the process. This robust functional-ity will enable payers to speed up the adjudication process, which in turn will improve cash flow for their provider networks, giving them a distinct competitive advantage.

D ATA S H E E T

S O LUTI O N Sybase is proud to offer the HIPAA Audit Solution that will allow the healthcare industry to ﬁnally realize the cost-saving beneﬁts that drove the enactment of the HIPAA transaction rules. This complete, end-to-end solution provides for auditing, reporting, and reconciliation of all claims entered into the system. Payers will now be able to monitor what causes slowdowns in the system and share that information with providers immediately, thus rectifying the backlog and potentially preventing future occurrences. This solution beneﬁts all parties involved. It allows payers to drive down operating costs, reduce exposure to regulatory mandates and increase trading partner satisfaction. In turn, providers will see an increase in cash ﬂow, decrease in

administrative effort, and prompt claims settlement.

B E N E F ITS ■ Tracking, reporting and reconciliation functionality—information can be monitored through the processing system to ensure claims are being adjudicated and paid in a timely manner. Increases adjudication system throughput—by handling EDI documents at the claim level, ■ compliant claims are immediately processed through the system while only noncompliant claims are rejected.

Understanding that 47 states have prompt pay laws, this solution enables payers to incor-porate business rules to audit their claims and identify settlement status, avoiding expo-sure to legal action.

With Sybase world class EDI technology,payers can send and receive all HIPAA transaction types. ■ 270/271 ■ 276/277 ■ 278 820 ■ ■ 834 835 ■ 837 P,I,D ■

NOW WITH THE HIPAA AUDIT SOLUTION, YOU CAN: ■ Audit ■ Report Reconcile ■ All HIPAA transaction types

EXTENSIVE FUNCTIONALITY: ■ Manage multiple trans-action types per batch Incorporate changes in ■ response to new busi-ness requirements Track all events and ■ generate summary reports Reconcile transactions ■ in vs. transactions out Provide audit points ■ and reports

FEATURED PRODUCTS AND SERVICES: ■ HIPAA Data Repository ■ HIPAA Transaction Manager ™ ■ RepConnector (optional) ■ Sybase Professional Services

Sybase Incorporated Worldwide Headquarters One Sybase Drive Dublin CA, 94568 USA T 1.800.8.SYBASE F 1.925.234.5678 www.sybase.com

■ Improves trading partner relationships and provider cash ﬂow—payers can track and report back to their providers key information from the claims system to help shorten the cycle for processing. ■ Supports dynamic application of business rules—auditing capabilities allow payers to identify bottlenecks in the system and implement rules instantaneously to improve information ﬂow. ■ Complete solution, one vendor—one phone call for all of your HIPAA transaction auditing, tracking, and reporting needs.

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