Microsoft Announces General Availability of BizTalk Accelerator for HIPAA

REDMOND, Wash., Oct. 30, 2001 — The problem facing MEGA Life and Health Insurance Company — the same one facing thousands of healthcare payers and providers — was daunting. The Texas-based firm, which insures more than 500,000 people and paid out US$300 million in benefits on more than two million claims last year, needed 18 months and a major outlay to bring its systems into compliance with HIPAA, the Health Insurance Portability and Accountability Act of 1996. And the clock was ticking: the U.S. government law set Oct. 16, 2002 for compliance, with violators facing possible fines and jail time.

Despite these concerns, MEGA needed not 18 months but just 70 days to implement key portions of its HIPAA compliance. The company is well positioned to meet the deadline and ready to respond quickly to HIPAA changes that are likely to be announced before October 2002, according to Sharon Dickson, vice president of claims and EDI for MEGA. What made the difference for MEGA was the Microsoft BizTalk Accelerator for HIPAA, a new solution for the healthcare industry, designed to enable HIPAA compliance as painlessly as possible.

“The Microsoft platform provides the agility to refine and optimize our internal business processes to a level far greater than I ever imagined possible,” says Phil Myhra, MEGA president. “Moving forward, we’re now in a much better position to be proactive and to set our own direction, rather than waiting for the future and simply reacting to it.”

HIPAA was designed to address a major problem plaguing the industry: Payers and providers speak a staggering 400 “languages,” as measured by the number of ways that providers have to be able to formulate insurance claims for reimbursement. That makes it tough for payers and providers to communicate effectively. When that communication goes awry, payments are delayed or denied, costs increase for all involved and ultimately, patients are the ones who suffer.

HIPAA sets uniform standards for healthcare transactions, so that payers and providers can, for the first time, speak a common language. But without a solution such as the BizTalk Accelerator for HIPAA, meeting those standards generally requires organizations to identify and rewrite millions of lines of software code in their transaction processing systems.

Microsoft’s BizTalk Accelerator for HIPAA

Microsoft will announce the general availability of the BizTalk Accelerator for HIPAA at today’s Windows on Healthcare conference in San Diego. It supports all 12 HIPAA transaction sets and manages the transactions as universally understood eXtensible Markup Language (XML) documents. Organizations still need to modify their processes to comply with the federal requirements — for example, they still need to conduct “gap analyses” that identify needed information they haven’t been collecting, as well as some types of information they must stop collecting — but the new solution provides business templates, test data, prescriptive architectures and more to take the sting out of that effort.

“We understand that many health care organizations are conservative in their approach to new technology,” says John Carpenter, healthcare-industry marketing manager for Microsoft. “They want to solve the HIPAA challenge with the least amount of risk, so they can focus on their primary business. The BizTalk Accelerator for HIPAA enables them to do exactly that because it creates HIPAA-compliant transactions based on the organization’s own data, mapped to the HIPAA requirements for expressing that data. The alternative is for an organization or its vendor to wade through 800 pages of implementation guidelines to figure out how to do this on its own — and then to hope that it hasn’t misinterpreted anything.”

The BizTalk Accelerator for HIPAA can be adopted as a standalone solution or it can become part of a software vendor’s broader solution. MEGA, for example, used the Accelerator as part of a solution created for it by technology provider HealthAxis Inc. Quality Care Solutions Inc. likewise incorporates the solution into its end-to-end healthcare transaction-processing solutions. Microsoft is also working closely with global systems integrators Cap Gemini Ernst & Young, Compuware Corp., and KPMG Consulting to deploy the solution.

“We find the BizTalk Accelerator for HIPAA to be enormously valuable to us as developers because we always have to invoke business processes in mapping a customer’s EDI data to HIPAA standards, and BizTalk’s Orchestration tools allow us to model those processes graphically instead of coding them manually,” says John Wall, chief technology officer for HealthAxis. The Pennsylvania-based firm provides a range of solutions to connect healthcare payers with consumers, providers and business partners. “That’s an enormous time and money saver for us, on the order of 10-to-1 over coding a business process without Orchestration. No other solution delivers the value we get by leveraging the BizTalk Orchestration abilities.”

An Innovative Partnership with the Authoritative Source on HIPAA

The BizTalk Accelerator for HIPAA is the result of an innovative partnership between Microsoft and Washington Publishing Company (WPC), the company chosen by the X12N HIPAA standard-setting body as the exclusive publisher of the HIPAA implementation guides and the authoritative source on HIPAA compliance. Because WPC provided the schema for the solution, healthcare providers and payers are assured of accurate schema for HIPAA compliance.

“This is the first time we’ve partnered with a software company,” says Lisa Miller, chief information officer of WPC, which is based in Rockville, Md., and publishes standards for industries as varied as transportation, petroleum, and retailing. “We did so because we see the BizTalk Accelerator for HIPAA as the ideal tool for hospitals, insurance companies, doctors and others seeking HIPAA compliance. Its orchestration capability allows it to manage the complex business processes involved in healthcare transactions and its translator capability allows it to exchange data seamlessly with legacy systems — allowing those systems to remain in service and for companies to maximize their return on investment in them and in existing staff and training. The BizTalk Accelerator for HIPAA is the most economical choice, and this is crucial in healthcare, where budget-strapped institutions can’t easily make major IT investments when money is needed to purchase life-saving equipment.”

Cutting Costs and Boosting Efficiency

Carpenter and Miller agree that, far from being a major expense, HIPAA compliance should become a major opportunity for healthcare payers and providers to update their processes to cut costs and boost efficiency. Providers, for example, will be able to submit claims more quickly, easily and less expensively, receive faster payments and gain a clearer understanding of what charges have been paid or declined, so they can pursue follow-up payments where appropriate. Insurance companies will be able to process claims more effectively and with reduced overhead, minimizing the need to maintain costly call centers and to process and return claims for non-covered expenses.

With providers and payers working together more effectively, patients are likely to benefit as well. For example, the BizTalk Accelerator for HIPAA could become part of a larger solution in which a doctor calls up details on a patient’s insurance coverage in real time, via the Internet, during the examination — enabling the doctor to recommend treatments and pharmaceuticals that are guaranteed to be covered by the insurer, or to give the patient informed choices between covered and non-covered therapies. Similarly, with referrals to specialists standardized under HIPAA, the solution can become part of a broader solution that handles referrals electronically, reducing or eliminating what can be a patient’s agonizing wait of several days to get a referral after receiving a diagnosis.

Based on its initial experience with the BizTalk Accelerator for HIPAA, insurance provider MEGA is already anticipating its benefits.

“I expect our Microsoft-based solution, when fully utilized by EDI-capable providers, will reduce claims processing costs by a minimum of 20 percent, returning our initial investment within a three-month period and tripling it within a year,” says MEGA’s Dickson.

“The experience of MEGA and others with the BizTalk Accelerator for HIPAA proves that HIPAA can be implemented positively and beneficially, and that this solution is the ideal tool for that implementation,” says WPC’s Miller. “With a universal standard in place and a great solution from Microsoft to support it, I envision entirely new solutions that will benefit providers, payers and — most important of all — patients.”

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