UICI
Rapid Solution for HIPAA Requirements
The Health
Insurance Portability and Accountability Act (HIPAA) was passed in 1996.
The Department of Health and Human Services published a final rule
regarding standards for electronic transactions in health care.
Currently health care organizations must comply by fall of 2003.
UICI is a
growing national health
and life insurance company. They focus on health
insurance policies covering individuals and families to the
self-employed, association group and student markets. UICI’s
catastrophic hospital and basic hospital-medical expense plans are
designed to accommodate individual needs, and include both traditional
fee-for-service indemnity plans and managed care options, such as PPO
plans and other supplemental types of coverage.
UICI engaged the Robert
E. Nolan Company to redesign their health claims process. The project
soon expanded to included assistance in a rapid application deployment
of a system to improve efficiency and become HIPAA compliant.
Redesigning the
Claims Process
UICI’s Insurance
Center
initially had no electronic data interchange (EDI) capabilities.
Claims were received in paper format, imaged, sent to a keying
outsource, reprinted for PPO repricing, returned and re-imaged before
going to the examiners’ queues.
During the Nolan
Process Redesign it was decided to implement a HIPAA-compliant EDI
process capable of receiving claims and automatically generating
responses. Additionally, the redesign called for the ability to perform
eligibility checks and automate the return of any non-qualifying claims,
as well as the ability to determine the proper repricing vendor and send
claims to them electronically.
UICI’s Insurance
Center
chose Healthaxis’ eHealthTalk solution and enrolled in Microsoft’s
BizTalk Early Adopter Program. In order to meet the fast paced schedule,
two teams were established.
Healthaxis’
e-HealthTalk Team
The Healthaxis team was
led by John Wall who was recognized as “Healthcare CTO of the Year” by
InfoWorld. They were responsible for deploying the Biztalk Accelerator
for HIPAA as a key integration component to the UICI legacy claim system
to accept and process inbound professional, institutional and dental
transactions. The implementation
involved providing an EDI, workflow and connectivity solution that
integrated the claims system and minimized internal changes and impact.
Nolan was responsible for making sure the business processes
remained aligned with the new
technology capability.
UICI’s BizTalk Team
The UICI Application
Solution Team (AST) was responsible for learning all aspects of BizTalk
necessary for ongoing production. They also were responsible for making
any changes necessary to accept EDI transmissions and processing them
through current claims systems. The
current system does not hold all data necessary for adjudication,
therefore modifications were required to receive the EDI claims into the
legacy systems. It was also necessary to reconstitute the claims data
into a format that could be fed to the imaging system.
Results
Together, Nolan, UICI
and Healthaxis achieved impressive results. This was a unique project
because it was the first implementation of the BizTalk Accelerator for
HIPAA. It involved being part of the Early Adopter Program, dealing with
the complexity of the Microsoft organization, working with beta code,
and learning while at the same time deploying.
In only 90 days, with
Nolan project management assistance, UICI has become an industry leader
in their ability to comply with HIPAA legislation. Results will include:
faster claims processing turnaround time; elimination of work steps such
as the manual keying of claims; improved accuracy; and, reduced errors.
In addition, when they begin using BizTalk, they will realize
an ongoing financial benefit of over
$2 million per year.
