Healthcare Technology Featured Article

October 30, 2015

How to Cure a Sick Healthcare Management System

There are a lot of problems ailing the modern healthcare industry, and, at times, many of them feel incurable.  There is one sickness, however, that is both easy to diagnose and easy to cure.  Inefficient, backlogged data management systems are an all-too-common affliction, but, thankfully, there is a clear remedy.  With the right integration software, the sluggish manual processes of an underperforming data system can be made efficient, robust, and healthy.  Here are three specific ways that the right integration software can help cure a sick healthcare management system:

Intelligent Data Architecture

Over 10% of health care claims require manual interventions by specialists, and it is not uncommon for some of these claims to end up over-billed or underpaid.  The reason for this is that many companies’ automated processes are not able to handle data variations or discrepancies. In order to manage the wide range of data variation, a vigorous data architecture is required in order to help manage revisions and provide business intelligence such as analyses of the conditions that lead to over-billing or underpayment.

Comprehensive Data Dictionary

Data inaccuracy is, unfortunately, a major symptom of a sick management system, but having a supportive and standard data dictionary to manage codes is a meaningful and accessible remedy.  Given that HIPAA codes that identify a patient's condition, status and procedures often change, an expansive data dictionary will streamline the process of both interpreting and acting upon the changing data codes.

Dynamic Data Validation

Providers sometimes change schemas of files by adding new fields and updating sets of codes that denote particular conditions, and this results in the difficulty of, yet again, data inaccuracy and also a failure to meet data standards. The remedy for this is a standard method of validating data which uses standard schema definitions to ensure that information received from a provider is accurate and meets data standards. Typically, companies use HIPAA X12 standards for sending claims or patient enrollments. However, the versions sometimes change or contain custom segments without the payer’s knowledge. Having a validation step to verify incoming data helps solve data errors by locating bad data before it becomes a larger problem.

Don’t let an ailing data management system weaken your entire organization. Take into consideration the above functionalities of a healthy integration solution and watch your business thrive. 

Raman Singh is director of sales engineering at Adeptia, a B2B integration software company that helps its customers achieve faster data on boarding. 

Edited by Kyle Piscioniere
By Special Guest
Raman Singh, Director of Sales Engineering, Adeptia ,

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