Success Story: A Recognized Leader in Health and Well-Being

Secure, HIPAA-compliant claims payment and processing with Axway MFT

  • Headquarters

    United States
  • Industry

  • Challenge

    Comply with service level agreements (SLAs) and increased regulations, security and interoperability standards by ensuring secure, guaranteed file transfer of highly sensitive claims data

  • Solution

  • Results

    • Authentication and encryption of sensitive documents and files
    • Controlled internal and external file exchanges with thousands of key trading partners
    • Scalability and security — data is secured while in transit, and solution can scale to support and monitor high volumes of data

As an industry leader in MFT and collaborative business solutions, Axway was selected as the preferred vendor to provide a solution for the secure, managed exchange of files containing highly-sensitive healthcare claims information.

As a recognized leader in health and well-being, this Health Plan Provider strives to improve the quality and effectiveness of health care for all Americans; creating a range of products and services that make health care more affordable, and using technology to make the health care system easier for consumers to navigate.

Serving approximately one third of the population nationwide, this organization operates numerous companies that provide a wide array of health care plans. It also contributes valuable data, research and consulting services for numerous entities, including life science companies, physicians, hospitals, employers, health plans and payers.

Improved Claims Processing Saves Millions of Dollars

Based on Axway managed file transfer (MFT) technology

Presented with the opportunity to launch enhanced, higher-quality claims payment and processing services, the Provider sponsored an initiative to improve support of mission-critical business systems and processes.

Results of an internal discovery process showed that the Provider had several limiting factors related to their technical environment that would need to be addressed in order to support the goals of the initiative:

  • Existing file transfer methods would not support the projected volume of files processed during normal business operations
  • Existing technologies could not provide guaranteed delivery of highly-sensitive consumer information
  • No tracking metrics or alert notifications were possible within the existing infrastructure

Recognizing that fines and penalties for health plans in violation of service level agreements and regulatory compliance requirements could be in excess of $10 million, the Provider decided to partner with a technology expert that could offer the security, scalability and stability they needed.

As an industry leader in MFT and collaborative business solutions, Axway was selected as the preferred vendor to provide a solution for the secure, managed exchange of files containing highly-sensitive claims information.

Security, Compliance and Scalability

Protecting masses of consumer data

One of the primary business challenges the Provider faced was to avoid penalties and fines due to failed service level agreements and/or regulatory requirements violations. Compliance with HIPAA regulations pertaining to privacy and security of confidential consumer information was essential. In addition, the Provider needed a solution that could:

  • Securely encrypt data in transit
  • ƒƒProvide robust authentication capabilities
  • ƒƒScale to support very high volumes during peak times
  • ƒƒDeliver end-to-end visibility and tracking metrics for all data movement
  • ƒƒSend alert notifications for better control of data exchange

Meeting the Evolving Needs of Health Plans

Across a network of thousands of partners

Over the span of one year, the transaction volume flowing through the Provider’s Axway gateway more than doubled in size. While peak volume periods — such as Open Enrollment — can cause a surge in the number of transactions, there are also increases in file size during off-peak times. With Axway MFT, the Provider can be confident that all data is secured while in transit, and that the solution can scale to support high volumes while still tracking all claims in detail. The Provider has thousands of trading partners, each of whom may submit multiple types of transactions, such as eligibility, claims, claim status, enrollments, authorizations and premium payments. The Provider was able to successfully on-board its many partners, no matter their connectivity requirements, and can now easily manage the trading partners using Axway MFT.

Axway MFT addressed key requirements established by the Provider, including:

  • Rapidly adapt at the business-process and technology levels
  • ƒƒMeet service level agreement and regulatory compliance requirements
  • ƒƒEstablish a HIPAA-compliant environment in which the Provider could offer enhanced file-transfer options to its customers
  • ƒƒManage business processes and transition IT from a reactionary organization to one supporting a real-time and dynamic enterprise
  • ƒƒProvide a system that includes all major secure file-transport protocols and enforces a standard process for managing file transfers
  • ƒƒOn-board and manage thousands of trading partners
  • ƒƒProvide a holistic approach that is sustainable, extensible and evolution-oriented
  • ƒƒRemove the need for “hidden” FTP scripts and ensure management of data in a common framework — in every part of the enterprise, on all systems, at all times

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