Published on 27-Dec-2011
"Sterling B2B Integrator has positioned us to take the lead in the healthcare industry." - Carlos Vargas, EDI and Integration Manager,Florida Hospital
Customer:
Florida Hospital
Industry:
Healthcare
Deployment country:
United States
Solution:
Smarter Commerce
Overview
Over the last century, Florida Hospital has grown from a 20-bed cottage to a 2,188-bed hospital, with seven locations throughout central Florida. Owned and operated by Adventist Health System, Florida Hospital is the largest Medicare provider in the US, and serves healthcare needs with a holistic approach designed to heal mind, body, and spirit.
Business need:
Florida Hospital recognized the need to upgrade their AIX-based IBM® Sterling Gentran® system to Sterling B2B Integrator to meet the real-time mandates of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA mandated the real-time transaction use of Insurance Eligibility (270/271) and Clinical Authorization (278) transactions.
Solution:
With Sterling B2B Integrator, Florida Hospital ensures regulatory compliance, with minimal disruption to current systems and processes. Sterling B2B Integrator replicates the EDI functionality provided by Sterling Gentran, and provides Florida Hospital with real-time connectivity, HIPAA compliance, and the flexibility to work with a diverse group of payers, vendors, and suppliers.
Benefits:
• Offers real-time
• Reduces costs
• Offers eligibility
Case Study
Customer background
Over the last century, Florida Hospital has grown from a 20-bed cottage to a 2,188-bed hospital, with seven locations throughout central Florida. Owned and operated by Adventist Health System, Florida Hospital is the largest Medicare provider in the US, and serves healthcare needs with a holistic approach designed to heal mind, body, and spirit. In 2008, Florida Hospital treated 1,071,000 patients. Third in the nation in heart procedures, Florida Hospital is a nationally recognized institute for cancer, cardiology, diabetes, orthopedics, and neuroscience.
Business challenge
Florida Hospital recognized the need to upgrade their AIX-based IBM® Sterling Gentran® system to Sterling B2B Integrator to meet the real-time mandates of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA mandated the real-time transaction use of Insurance Eligibility (270/271) and Clinical Authorization (278) transactions. Sterling B2B Integrator offers these solutions. “Sterling Gentran is a robust product that did batch translation very well,” said Carlos Vargas, EDI and Integration Manager for Florida Hospital, speaking about their previous system. “But the healthcare industry is expanding real-time capabilities to include claim status, claim submission and claim adjudication, and Sterling Gentran could not support that,” said Ned Palmer, EDI Team Lead Developer.
Whether for surgery with next-day requirements, treatment authorization, or timely payment, Florida Hospital needed a secure, flexible, real-time system to offer the best service possible.
Solution
With Sterling B2B Integrator, Florida Hospital ensures regulatory compliance, with minimal disruption to current systems and processes. Sterling B2B Integrator replicates the EDI functionality provided by Sterling Gentran, and provides Florida Hospital with real-time connectivity, HIPAA compliance, and the flexibility to work with a diverse group of payers, vendors, and suppliers.
As to finances, Sterling B2B Integrator enables Florida Hospital to submit patient insurance eligibility inquiries in real-time, increasing admissions speed and accuracy, and reducing receivables by confirming co-pays and non-covered amounts before elective services are rendered. Treatment authorizations, currently under development, will enable Florida Hospital to receive real-time approval for a specific procedure, thereby ensuring full payment of contracted amounts.
“After implementation we have discovered other innovative features in Sterling B2B Integrator in addition to EDI Mapping,” said Vargas. “It is a major benefit to the hospital now and will continue to be in the future.”
Key benefits
Real-time
Sterling B2B Integrator offers Florida Hospital the real-time visibility it needs to maintain its lead in healthcare. Real-time helps the admissions process to be faster and more efficient, with early payment discounts and sharp reductions in manual paperwork and human error. In addition, their level of service has improved because they can ensure next-day requirements and the necessary supplies for patient care.
Reduced cost
With Sterling B2B Integrator, Florida Hospital has reduced cost, improved cash flow management, and increased cash collections while controlling bad debt. It helps ensure timely payment of vendor invoices to maximize available discounts, and avoid late payment charges. Based on scheduled surgical cases, Sterling B2B Integrator enables Florida Hospital to electronically order supplies as needed to stock just-in-time inventory, lowering carrying costs.
Eligibility
In addition to the traditional EDI and financial transactions, Florida Hospital is able to complete healthcare-specific transactions covered under the HIPAA laws.
Products and services used
IBM products and services that were used in this case study.
Software:
Sterling B2B Integrator
Footnotes and legal information
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