Lightwell Healthcare B2B Gateway Solution Guide
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The Lightwell Healthcare B2B Gateway is designed to reduce risk, cost, and complexity in healthcare processes by securely exchanging and automating data transactions among partners. It addresses common issues such as errors, delays, HIPAA compliance, and costly manual processes, while providing real-time visibility and proactive management capabilities. This solution ultimately increases efficiency, improves patient care, and helps organizations avoid legal and financial penalties.
Lightwell Healthcare B2B Gateway Solution Guide
- 1. Reducing Risk, Cost and Complexity Across Healthcare Processes With the Lightwell Healthcare B2B Gateway
- 2. Introduction: Persistent Pains for Healthcare Organizations Today’s healthcare organizations must provide high-quality services while meeting rigorous industry requirements. Their IT teams face tremendous pressure, as they must support more data formats, partners, protocols, devices, systems, requirements, and end users than ever before. Despite these challenges, they must ensure that critical data flows quickly and flawlessly between internal systems and with their partners, because there is little room for error or delay in the exchange of healthcare transactions. Delays and errors can lead to a wide range of problems, including a patient not receiving the care they need when they need it most. This could be catastrophic. However, because healthcare processes are so complex and often require human intervention, errors and delays are far too common. Addressing these errors—combined with the need to ensure HIPAA compliance, meet SLAs, prevent data breaches, and support a growing number of partners and customers/patients—has created a tremendous amount of pain for many healthcare organizations. Here are just a few examples of the impact. Resource Time and Costs There are many steps in the lifecycles of healthcare transactions—including enrollment, eligibility, claims, claim inquiry, and payments—where data is exchanged between organizations. Errors or delays in any of these steps can prevent the next step from happening, resulting in delayed treatment, delayed payments, SLA penalties…or worse. Unfortunately, most organizations don’t have an easy way to know if and when a failure or error occurred along the way, and can’t easily identify the problem within a transaction set that contains a large amount of data. Because of this, healthcare organizations must spend excessive time and money to: • Research, identify and fix errors • Revise and resend transactions • Reconcile claims and payments • Communicate transaction status with their partners Full-time staff may be dedicated to researching and fixing errors, and often, organizations must pay overtime to overcome these challenges. This is very costly, and ties up valuable resources. 2
- 3. HIPAA Violations and Other Penalties In addition, with multiple individuals manually reconciling data, personal and private information is being accessed, this puts the organization at risk of non-compliance. If personal health data is breached, there can be a significant per-incident HIPAA fine for each record breached. In addition, organizations frequently lack records of who accessed files, when they did, and what was done. This lack of audit trail could lead to costly legal problems and HIPAA and PCI violations. Lack of Visibility At a management and executive level, healthcare organizations lack visibility into these issues, and are challenged to identify and address the sources of problems. They may become aware of a problem long after it has worsened—perhaps even blind sided—while the problem could have been avoided with early detection. All of these challenges can lead to big problems in the healthcare industry, and for many organizations they persist despite investments in multiple systems, solutions—even custom developed scripts—to support these processes. Security Risk Manual research and reconciliation processes are problematic, not only because of the costs and risk of error, but also because they create a huge security risk. Data can easily be stolen when it is downloaded and managed in a non-secure environment—an individual’s desktop, stored on a USB, or sitting on a desk. In addition, there is risk of fraudulent activity, as an individual could set up a fraudulent account and manipulate claims. This has the potential of becoming a front-page nightmare for companies. Financial Loss Beyond staff-related costs, there is also potential for financial loss. When a provider organization can’t easily reconcile what has been billed versus what has been received, and what has been paid versus what has been deposited, they may be missing out on payments they’re owed. On the other hand, if a payer makes a mistake and payments aren’t made correctly or on time, they may be penalized and/or lose their discounts. Reducing Risk, Cost and Complexity Across Healthcare Processes 3
- 4. Overcoming the Pains: The Lightwell Healthcare B2B Gateway Recognizing the impact of these challenges, we developed the Lightwell Healthcare B2B Gateway solution through our partnership with IBM. At its foundation, the solution provides the proven capabilities needed securely exchange healthcare data with all partners, quickly transform high volumes of data, and automate complex healthcare processes. In addition, it provides the powerful capabilities needed to overcome the challenges described herein, address HIPAA requirements (levels 1-7), and reduce risk, cost and complexity across healthcare B2B processes. Leveraging the best-of-breed capabilities of the IBM B2B Integration and Managed File Transfer solutions, along with Lightwell’s proven B2B Framework, the Lightwell Healthcare B2B Gateway solution helps healthcare organizations: • Automate complex B2B processes, including enrollments, eligibility, authorizations, claims, and payments • Securely exchange all transaction types and formats with partners • Reduce transaction errors and the costs of addressing them • Reduce the time and effort required to research and reconcile transactions • Gain end-to-end, real-time visibility and control throughout the transaction lifecycle • Provide authorized staff and partners a secure, self-service web-based environment for viewing and managing transactions • Identify and address problems proactively • Avoid penalties while ensuring HIPAA (all SNIP levels 1-7) and SLA compliance • Reduce the risk of security breaches Furthermore, it helps to provide personalized dashboards and reporting to key individuals, helping them keep a pulse on activities as they happen, while helping them view valuable trends around transactions, performance, payments, and more. All of this can help them address the source of problems while gaining insights for better decision making. As a result, companies reduce costs, improve processes, increase security, reduce risk, and increase patient and partner satisfaction. 4
- 5. Leveraging a combination of IBM B2B Integration and Managed File Transfer solutions, along with the Lightwell B2B Framework, the Lightwell Healthcare B2B Gateway provides a wide variety of capabilities. Healthcare B2B Gateway Capabilities at a Glance • Encryption of data in motion and at rest • Role-based permissions with identity and access management, multi-factor authentication • Integration with enterprise security infrastructure • Perimeter security • Real-time document tracking • End-to-end document lifecycle visibility • Visibility into where claims are in the adjudication business process DOCUMENT, TRANSACTION AND CLAIM VISIBILITY • Centralized reporting on all data exchange events • Real-time notifications and alerts of problems and failures • Highly-personalized, configurable dashboards with drill-down capabilities ALERTS AND REPORTING • Automatic SLA/SLC monitoring and alerting • Audit trails to easily support yearly audits • Compliance with WEDI/SNIP (Levels 1-7) standards HIPAA AND SLA COMPLIANCE • Supports any-to-any transformation • Supports AI maps and ITX maps (built in HIPAA standards) • Supports pre-validation, validation, and data enrichment for improving auto-adjudication rate TRANSFORMATION AND AUTOMATION • Exchange all transaction types and formats with partners • Any-to-any integration, any-to-any protocol • Real time or batch communications • Rapid partner onboarding B2B COMMUNICATION AND COLLABORATION SECURITY Reducing Risk, Cost and Complexity Across Healthcare Processes 5
- 6. Advanced Capabilities Provided by the Lightwell B2B Framework In addition to those provided by the IBM solutions, the Lightwell B2B Framework brings a powerful set of capabiities to the Healthcare B2B Gateway. Powerful Search Capabilities Users can easily search on transactions through a wide variety of criteria, including Claim IDs, Patient Identity Codes, Subscriber and Group IDs—whatever data is meaningful to the company. This decreases the time and cost to locate specific transactions and claims. End-to-End Document Lifecycle Tracking Users can easily find and view related transactions in a lifecycle, enabling them to quickly reconcile transactions while reducing the time and costs involved. This can help ensure timely patient treatment and accurate provider payment. Simplified Resending and Reprocessing Capabilities Users can quickly reprocess and resend healthcare documents as needed. This decreases time and cost, while reducing the amount of human intervention required. Secure Access via Web Portal for Authorized Business Users and Partners With B2B Framework, access to transaction information can be extended—safely and securely—to authorized individuals inside and outside the company. The data is kept within the B2B Framework (not downloaded to a desktop) while an audit trail keeps a record of activity. This protects sensitive data while ensuring HIPAA compliance. In addition, by empowering these users to view the status of their transactions on their own, it reduces the number of internal and external status inquiries to IT staff while improving satisfaction. Proactive Alerts B2B Framework keep managers and partners informed of performance issues and transaction processing issues. It alerts the right individuals about issues immediately and automatically so they can quickly address them. Streamlined Partner Onboarding and Management B2B Framework simplifies and streamlines the partner onboarding process, reducing trading partner onboarding time from days or weeks to hours or minutes. It comes with rules-based configuration and dozens of pre-built process flows out-of-the-box, so no custom development is required to onboard a partner. This reduces the cost of trading partner onboarding while improving time to revenue from B2B relationships. Individualized Dashboards and Advanced Reporting B2B Framework provides individualized dashboards and reporting that enables desginated personnel across the organization to gain insights around areas that matter most to them, including: business performance (by geography, transaction type, and more), operational performance, and partner performance. Reports are highly configurable and individuals can drill down into the data for greater detail as needed. Equipped with powerful insights, managers and executives can take action on trends and make better-informed decisions. 6
- 7. Reduced Cost • Significant reduction in resource time and costs associated with managing, reconciling and remediating errors and issues throughout healthcare processes • Reduction of support calls and status inquiries from internal staff, partners and customers as a result of providing them visibility into transactions • Reduced management, maintenance and support costs by consolidating onto an easy- to-use, highly scalable enterprise B2B system Reduced Risk • Reduced risk of data security breaches, and avoidance of related costs and fines associated with them • Faster detection and resolution of problems and issues at multiple levels through real-time dashboards and alerts Avoidance of Penalties • Compliance with legal and industry standards and avoidance of HIPAA and SLA-related penalties Increased Productivity • Increased productivity by reducing manual processes and freeing up valuable resources Improved Business Performance • Improved performance through better visibility into day to day operations and issues • (For Providers) Acceleration of revenue by improving payments processing and addressing payment issues easier • (For Payers) Avoidance of late payment penalties and reduction of “where’s my payment” inquiries • Improved market intelligence and decision-making based by extending real-time insights to managers and executives Increased Satisfaction • Strengthened partner relationships by making it easy to do business with you • Improved customer service, patient care, and patient satisfaction Furthermore, because the Healthcare B2B Gateway was developed with flexibility in mind, it will enable you to quickly respond to new mandates and regulations in this time of rapid political and industry change. You’ll be able to support new processes, rules, protocols and formats within this system, while easily integrating with other systems as needed to support changing requirements. In addition, your organization will gain numerous competitive advantages as it is able to spot trends and opportunities quickly, deliver higher levels of customer service, and develop new revenue- generating offerings. Benefits of the Lightwell Healthcare B2B Gateway Learn more about the Healthcare B2B Gateway and what it can do for you. Contact Lightwell today at info@lightwellinc.com or call us at (614) 310-2700. CONNECT WITH US Reducing Risk, Cost and Complexity Across Healthcare Processes 7
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