UICI

Rapid Solution for HIPAA Requirements

The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996. The Department of Health and Human Services published a final rule regarding standards for electronic transactions in health care. Currently health care organizations must comply by fall of 2003.

UICI is a growing national health and life insurance company. They focus on health insurance policies covering individuals and families to the self-employed, association group and student markets. UICI’s catastrophic hospital and basic hospital-medical expense plans are designed to accommodate individual needs, and include both traditional fee-for-service indemnity plans and managed care options, such as PPO plans and other supplemental types of coverage.

UICI engaged the Robert E. Nolan Company to redesign their health claims process. The project soon expanded to included assistance in a rapid application deployment of a system to improve efficiency and become HIPAA compliant.

Redesigning the Claims Process

UICI’s Insurance Center initially had no electronic data interchange (EDI) capabilities. Claims were received in paper format, imaged, sent to a keying outsource, reprinted for PPO repricing, returned and re-imaged before going to the examiners’ queues.

During the Nolan Process Redesign it was decided to implement a HIPAA-compliant EDI process capable of receiving claims and automatically generating responses. Additionally, the redesign called for the ability to perform eligibility checks and automate the return of any non-qualifying claims, as well as the ability to determine the proper repricing vendor and send claims to them electronically.

UICI’s Insurance Center chose Healthaxis’ eHealthTalk solution and enrolled in Microsoft’s BizTalk Early Adopter Program. In order to meet the fast paced schedule, two teams were established.

Healthaxis’ e-HealthTalk Team

The Healthaxis team was led by John Wall who was recognized as “Healthcare CTO of the Year” by InfoWorld. They were responsible for deploying the Biztalk Accelerator for HIPAA as a key integration component to the UICI legacy claim system to accept and process inbound professional, institutional and dental transactions. The implementation involved providing an EDI, workflow and connectivity solution that integrated the claims system and minimized internal changes and impact. Nolan was responsible for making sure the business processes remained aligned with the new technology capability.

UICI’s BizTalk Team

The UICI Application Solution Team (AST) was responsible for learning all aspects of BizTalk necessary for ongoing production. They also were responsible for making any changes necessary to accept EDI transmissions and processing them through current claims systems. The current system does not hold all data necessary for adjudication, therefore modifications were required to receive the EDI claims into the legacy systems. It was also necessary to reconstitute the claims data into a format that could be fed to the imaging system.

Results

Together, Nolan, UICI and Healthaxis achieved impressive results. This was a unique project because it was the first implementation of the BizTalk Accelerator for HIPAA. It involved being part of the Early Adopter Program, dealing with the complexity of the Microsoft organization, working with beta code, and learning while at the same time deploying.

In only 90 days, with Nolan project management assistance, UICI has become an industry leader in their ability to comply with HIPAA legislation. Results will include: faster claims processing turnaround time; elimination of work steps such as the manual keying of claims; improved accuracy; and, reduced errors. In addition, when they begin using BizTalk, they will realize an ongoing financial benefit of over $2 million per year.