Trustmark Turns Healthcare Challenge Into e-Business Opportunity; Software Interfaces Exceed HIPAA Requirements

Trustmark Insurance Turns Healthcare Challenge Into Opportunity

Snapshot

Organization Trustmark Insurance Company, of Lake Forest, IL, a major health insurance and benefits-administration company that serves more than 2 million covered lives and processed approximately 14 million claims in 2000.

The Challenge Adapt its systems to new regulations without losing sight of long-range business objectives, such as new e-business opportunities.

The Strategy Use HIPAA as the catalyst to build a fast, flexible business, compatible with new U.S. government healthcare regulations.

The Results Rapidly designed and built critical pieces required to meet government standards for specific HIPAA transaction sets while laying the foundation for new e-business initiatives, such as Web services and XML compatibility.

iWay Software Solution iWay XML Transformation Engine; iWay Adapters for HIPAA, DB2, and VSAM; iWay Connector for Java™; iWay Plug-In Developer Suite for IBM WebSphere MQ Integrator.

When the federal government drops 7,000 pages of regulations and guidelines on your desk and gives you a deadline to meet them, you have a number of options, including:

Do as little as possible to scrape by
Look at it as an opportunity

Trustmark Insurance Company, which offers a full line of health, life, dental, disability, and other insurance to more than 2 million covered lives, elected to take the latter course, says Nasser Farimani, vice president of information systems technology.

"We could have taken the easy option and done the minimum to remediate our existing systems," he says, "but we looked at this as an opportunity to move forward with e-business and systems integration projects."

Meeting the HIPAA Challenge – and Beyond

The catalyst, in this case, was the Health Insurance Portability and Accountability Act (HIPAA), which has defined new standards for electronic healthcare documents in the United States in an effort to reduce healthcare costs and improve the security of health records. Organizations that don't meet the HIPAA implementation deadlines will be unable to process government insurance claims and will find themselves unable to exchange insurance and healthcare records with other healthcare organizations. Although Trustmark employed relatively advanced technologies for managing healthcare documentation, including Electronic Data Interchange (EDI), the new standards required modifications to the company's systems.

But Trustmark was looking beyond the HIPAA deadline. It recognized that, if implemented correctly, HIPAA can provide a major strategic advantage over the long-term through closer integration of business processes and streamlining of back-office operations.

To achieve this, Trustmark decided to standardize its system-integration efforts around open standards, such as XML, and solutions from IBM and iWay Software.

iWay Tailored for Web Services

iWay's solution turned out to be the perfect fit for Trustmark's key requirements: a system that could take incoming requests for the status of a health claim, match the request with the proper claim, identify its status, and respond immediately (technically called a HIPAA 276/277 Claim Status Request/Response). HIPAA defines several such standard transaction sets; iWay's software is capable of handling all of them.

iWay has also built intelligent adapters that connect with more than 200 existing applications, transaction systems, and databases. It integrates easily with IBM WebSphere, the application integration and Web services platform that Trustmark had already selected for its future e-business initiatives. iWay also works with IBM message-queuing systems, which are critical to a project that relies heavily on asynchronous exchange of messages. The final touch: iWay had already built an iWay HIPAA e-business adapter that ensures HIPAA documents and requests are properly formatted and validated.

The iWay XML Transformation Engine provides a workbench with a drag-and-drop interface, which made it easy for Trustmark to build a system that could identify an XML request, map the data in the request (such as a claim number) to an EDI-formatted healthcare claim, and build the appropriate query to retrieve data from Trustmark's VSAM and DB2 databases.

Farimani says iWay's comprehensive set of adapters made it an ideal choice for connecting legacy systems to new technology such as WebSphere, XML, and message queues.

Farimani says, "We found the iWay solution the easiest to use in terms of EDI to XML mapping, the most flexible in terms of its integration capability with MQ and MQSI, the fastest in terms of speed of implementation, the most comprehensive and end-to-end in terms of its legacy integration capability." Trustmark will use iWay's solution to implement HIPAA fully and will probably look into other iWay adapters for wider legacy-systems integration.

Remarkably, Trustmark was not required to abandon its significant investment in EDI technology and mainframe back-end systems, as many organizations affected by HIPAA have felt compelled to do. Indeed, some observers have called HIPAA the "Y2K of healthcare" because of the massive changes it imposes on this huge industry.

But Farimani is confident that iWay's software has made such upheaval unnecessary for Trustmark.

"We have not had to do this, and we probably won't do it until there is a good business reason," he says calmly.

Spending Only on the Future

The finished solution will save both Trustmark and its customers considerable effort and time in the future. For example, instead of phoning Trustmark, proving their identity, and waiting for a customer-service representative to retrieve claim information, both corporate partners and individual customers can send electronic requests that will reply almost instantly with the claim status.

But that's only the beginning of the benefits, says Farimani. iWay's software has blazed a path for the company as it works on plans to make more of its back-end processes accessible as Web services. It has demonstrated that XML, a relatively new technology, really can reduce investments and system support costs and is capable of delivering complex services in real time for customers.