HIPPA Compliance for HealthCare Organization:

Overview:

The client being a subsidiary of a giant HealthCare Organization is one of the largest not-for-profit managed care providers in the US. Serving more than 4.5 million members, the company offers PPO, and traditional indemnity health insurance plans. The client also offers Medicare supplement plans, as well as, vision, and dental plans including disease management services for medical conditions such as asthma, diabetes, and heart disease through its affiliate LifeMasters® Supported SelfCare.

Business Need

The company wanted to enforce compliance with HIPAA (Health Insurance Portability and Accountability Act) rules and the key area here was the Individual Rights System. The company therefore wanted a Microsoft .Net application to provide business users the facility to maintain and inquire various member rights Information and disclosure tracking details.

Challenges and Requirements:

• The Individual rights system was a key part of HIPAA compliance, and since the law is very strict about the rights of patients, the client wanted a solution that would address all the areas of conformity.
  
• The company wanted a web-based application that would be available on the corporate intranet across nine states in the USA. To ensure this, Eminence had to design a robust system with high uptime so that users faced no problems.
  
• The system had to be robust because it would face several concurrent requests per second. Since the user base was also expected to grow, it had to scale up and continue efficient operations even if the load went up.

Eminence Role

The eminence team, spent 18 months implementing the project. To ensure that a system completely matched the client's specifications was created, Eminence used the Global Delivery Model (Onsite/Offsite/Offshore) to cut costs and ensure high efficiency. The .Net solution provided by eminence included both online accessibility and batch processes that optimized the processing of the raw data.

The system supported tracking the Individual Rights and Disclosures of all Members and Applicants. The application scope covered a variety of member rights like Authorizations, Confidential communication, Disclosure Accounting, Access Request, Access Denial, Access Appeal, Amend Request, Amend Denial, Amend Appeal, Complaints, Objections, Restrictions, Marketing Opt-In, etc. The application also generated several predefined reports.

Benefits

The .Net solution that eminence created for the client provided the following benefits:

• The system was fully HIPAA compliant and ensured that all the individual rights were taken care of, thus boosting the confidence of the client's customers.
• The application was available to users spread across various states, and this enabled better processing of information.
• The robust nature of the system ensured that though there was a user base of 3,000 users, it was still possible to handle 50 concurrent requests every second.

Most importantly, the demonstrator proved beyond a shadow of doubt that tangible benefits could be accrued by modernizing healthcare, and showed that the experiments could be reproduced nationwide.