B2B Data Exchange for Healthcare Payers Hub
HIPAA transaction standards are a well-established reality for health plans in the United States, with essentially every plan having implemented a first-generation B2B solution focused on the immediate need for a compliant solution for accepting HIPAA transactions. This made good sense at the time, as many plans were playing catch-up as a result of HIPAA falling so shortly on the heels of Y2K, and in many cases the 4010 version of the standards were insufficient to support the complexities of real-world business processes.
The new 5010 HIPAA transactions represent an opportunity for health plans to move beyond HIPAA as simply a compliance problem and begin to derive business efficiencies from enhanced B2B integration with trading partners. Informatica’s B2B Data Exchange™ for Healthcare Payer’s Hub solution is designed for just this opportunity, providing an enterprise-class solution for health plans to synthesize all of their B2B functions on a single platform, while retaining features essential to HIPAA compliance.
With capabilities surpassing the usual B2B solutions, Informatica B2B Data Exchange allows you to support the expanding diversity of customers, partners, and their data:
- Comprehensive data transformation, including unstructured and structured data
- Pre-emptive data quality to prevent poor data from entering the system
- A robust, scalable infrastructure that ensures multi-enterprise visibility
Although not a rewrite of the HIPAA standards, version 5010 represents a significant revision that resolves many of the limitations inherent in the early versions of the transactions. These changes, paired with the power and flexibility of Informatica B2B Data Exchange, supply a compelling vision for health plans to move to a next-generation architecture for HIPAA compliance:
- Easily accommodate a single environment that can handle 4010A transactions, 5010 transactions in test or production, and varying levels of validation depending on individual trading partner agreements
- Support high-performance, robust business logic that may be required external to legacy applications during the transition from ICD-9 to ICD-10
- Facilitate a seamless transition to real-time automation of pre-authorizations, approvals, and other transactions
- Consolidate all B2B activity on a common platform that supports full HIPAA functionality, along with handling non-HIPAA transactions and transactions with noncovered entities
- Validate, parse, transform, and deliver data contained in incoming HIPAA transactions to a variety of other destination systems in a variety of formats, such as date warehouses or care management applications
- Benefit from native support for XML so plans can adopt any of the emerging XML standards when they’re ready
The time is past for siloed B2B solutions focused specifically on HIPAA compliance to have a place in a modern health plan’s B2B architecture. Informatica’s B2B Data Exchange for Healthcare Payers Hub solution offers the best of both worlds, providing a robust solution for traditional compliance-focused processing paired with the power and flexibility for plans to fully exploit the potential inherent in the transition to version 5010 and ICD-10.