BUSINESS PROCESS REDESIGN IN HEALTHCARE: TOWARDS A STRUCTURED APPROACH
Author: INFOR

Ever since the passage of the Health Insurance Portability & Accountability Act of 1996, the health-care community has been moving toward a more standardized format for handling claims. A key provision of HIPAA, titled Administrative Simplification, calls for improved efficiency in health-care delivery by standardizing EDI, or electronic data interchange, and protecting the confidentiality and security of health-care data through setting and enforcing standards.

In response to HIPAA, along with growth in new technology designed to automate the medical claims management process, an increasing number of health-care providers have begun accepting electronic claims transactions from providers, health-care clearinghouses, billing entities and other third parties involved in the claims-handling process. As a result, the claims management process is growing increasingly more streamlined, as payers aim to reduce administrative expenses and promote partnerships with providers.

"There has been a great deal of effort invested in the last five to six years by health-care payers assessing the capabilities of their current systems regarding the privacy, security and administrative simplification provisions of HIPAA," says Laurie Ringlein, director, health industries advisory practice, at PriceWaterhouseCoopers in Portland, Ore.