Validating coverage
and processing claims is complex. Payer organizations must convert formats
of claims from HIPAA X12, designed and maintained by the American National
Standards Institute (ANSI), to the format required by the Payers Adjudication
System, and process that claim through the system. Payers need solid,
scalable solutions that will give them an advantage over their competition
while, at the same time, enable them to maintain strong relationships
with their healthcare partners.
Sybase offers four broad categories
of Payer solutions:
Integration -- These
solutions help protect a payer’s investment in legacy systems
and enable it to update multiple databases as needed.
- Unwired
Orchestrator — Offers intuitive, easy-to-use tools encased
in a comprehensive architecture that joins internal and external
systems into a single operational unit. Unwired Orchestrator's
innovative technology encourages collaboration, thereby simplifying
the task of streamlining and optimizing payer business processes.
- RepConnector – Extracts data from existing applications, such as databases,
and shares it with integration tools such as integration brokers
and application servers.
Process Improvement --
These solutions improve the payer’s message handling and eligibility
verification as well as analytics. Analyze diseases, claims, treatments,
etc., to improve pricing of services.
-
Industry Warehouse Studio for Healthcare Analytics — Pre-built business intelligence application suite for the
healthcare industry structured to leverage a customer-centric data
warehouse infrastructure. This solution is specifically designed
to exploit the transaction-level data in a typical healthcare organization.
Security -- These solutions
help providers meet the contingency planning, data backup, and disaster
recovery provisions of the HIPAA Security Standards — and provide
for the backup of patient data.
- Replication
Server — Simplifies data movement and synchronization across the
enterprise. It allows DBAs to quickly setup redundant disaster recovery
sites and synchronize data across heterogeneous database platforms
HIPAA -- These
solutions address HIPAA
regulations and CMS mandates.
|
