Are you an insurer worried about integrating to state & federal marketplaces? Are you worried about cost, technology infrastructure, strategy, complexity and deadlines?
This white paper addresses these concerns and more. Learn what steps you need to take and what pitfalls to avoid. Let hCentive be your guide through this challenging and changing landscape.
hCentive's WebInsure Consumer is the perfect solution for insurers looking for a proactive approach towards web based insurance solutions. WebInsure Consumer simplifies the implementation of the complex health reforms and offers a cost-effective and highly tailored solution for insurers looking to leverage retail-focussed opportunities arising in the industry.
Building Effective Denial Management DashboardsCitiusTech
In this whitepaper, we try to create dashboards from the lens of “Coding and Compliance Managers” – the real users who rely upon these dashboards regularly to help financially sustain a facility.
Importance of URAC Accreditation for Health PlansCitiusTech
Utilization Review accreditation Commission (URAC) is one of the two major organizations which accredit health plans on various healthcare quality measures.It is a Washington DC-based, nonprofit, independent organization founded in 1990, recognized by 46 states, District of Columbia, and 6 federal agencies
The Future of RCM in Healthcare OrganizationsCitiusTech
This document / whitepaper talks about how healthcare technology companies can leverage emerging technologies to derive insights to improve their Revenue Cycle Management process.
Solutions to Accelerate Compliance with Affordable Care Act (ACA) Mandates an...Lightwell
The healthcare payer ecosystem in the United States has changed dramatically over the last decade and is expected to evolve at an even faster pace over the next few years. Many world-class companies involved in healthcare payment processing are finding themselves constrained by their existing information technology infrastructure. The silos that they built around Business to Business (B2B) processing are constraining them, making it difficult to achieve governmental mandates and (more importantly) increase processing efficiency and competitive advantage.
The payers’ world today requires adherence to multiple industry standards, government regulations, and industry expectations. It is becoming more technical and payers need to become more agile (Figure 1). The IBM Standards Processing Engine Solution for Healthcare Payers is your answer to B2B enablement in today’s complex HIPAA/ACA (Affordable Care Act) world.
hCentive's WebInsure Consumer is the perfect solution for insurers looking for a proactive approach towards web based insurance solutions. WebInsure Consumer simplifies the implementation of the complex health reforms and offers a cost-effective and highly tailored solution for insurers looking to leverage retail-focussed opportunities arising in the industry.
Building Effective Denial Management DashboardsCitiusTech
In this whitepaper, we try to create dashboards from the lens of “Coding and Compliance Managers” – the real users who rely upon these dashboards regularly to help financially sustain a facility.
Importance of URAC Accreditation for Health PlansCitiusTech
Utilization Review accreditation Commission (URAC) is one of the two major organizations which accredit health plans on various healthcare quality measures.It is a Washington DC-based, nonprofit, independent organization founded in 1990, recognized by 46 states, District of Columbia, and 6 federal agencies
The Future of RCM in Healthcare OrganizationsCitiusTech
This document / whitepaper talks about how healthcare technology companies can leverage emerging technologies to derive insights to improve their Revenue Cycle Management process.
Solutions to Accelerate Compliance with Affordable Care Act (ACA) Mandates an...Lightwell
The healthcare payer ecosystem in the United States has changed dramatically over the last decade and is expected to evolve at an even faster pace over the next few years. Many world-class companies involved in healthcare payment processing are finding themselves constrained by their existing information technology infrastructure. The silos that they built around Business to Business (B2B) processing are constraining them, making it difficult to achieve governmental mandates and (more importantly) increase processing efficiency and competitive advantage.
The payers’ world today requires adherence to multiple industry standards, government regulations, and industry expectations. It is becoming more technical and payers need to become more agile (Figure 1). The IBM Standards Processing Engine Solution for Healthcare Payers is your answer to B2B enablement in today’s complex HIPAA/ACA (Affordable Care Act) world.
The value of pre adjudication in healthcare claims processing - banc tec's wh...Jone Smith
BancTec provides Healthcare payers and benefit administrators with pre-adjudication technologies thus replacing error-prone human process and providing application for document management, PPO network management etc.
Reducing Risk, Cost and Complexity Across Healthcare Processes With the Lightwell Healthcare B2B Gateway. The Lightwell Healthcare B2B Gateway solution helps healthcare organizations address HIPAA requirements (levels 1-7) while reducing risk, cost and complexity across their B2B processes.
Cutthroat competition and high regulation is squeezing bottom-lines of insurance companies. Moreover, if the claims processing is slow and document management is not seamless, the profits can dwindle further. One way to offset these impediments is to modernize claims processing and document management by collaborating with companies having deep domain expertise in these areas. HCL shows how this can be achieved.
Independent consultant since 1996 with over 30 years of experience with Healthcare Information Systems; Expertise in healthcare industry, project management, business analysis, business administration/operations, Electronic Data Interchange (EDI), Electronic Medical Record (EMR), Physician Practice Management (PM), Health Information Exchange (HIE), testing, training, support and consulting; Experience working directly with providers, payers, software manufacturers, electronic data interchange organizations, billing services, clearinghouses and government agencies; Excellent skills for communication, technical research and problem-solving. Efficient and effective leadership for cost effective solutions.
These slides are the property of Chilmark Research and have been published with their permission.
-
Population Health Management (PHM) has been in the health IT lexicon for nearly a decade, yet the industry still lacks a clear definition of how provider organizations extract value from their PHM initiatives. Part of the problem is that PHM is often defined as a technology solution when it, in fact, is not. Rather, PHM is a technology-enabled strategy that includes a multitude of capabilities (e.g., interoperability, analytics, care management, engagement, etc.) and services. Secondly, an organization adopts a PHM strategy to support its value-based care (VBC) contracts, but VBC remains an elusive target that is highly dependent on local and regional conditions.
In this presentation, John Moore briefly walks through the evolution of the PHM market and its increasingly integral tie to VBC and future technology and market trajectories. Highlighted topics include EHR versus best-of-breed solutions, FHIR and open APIs, and the increasing role of IT-enabled services.
Learning Objectives:
- Reframing PHM: Defining PHM as a strategy, not a product.
- Core elements of a technology-enabled PHM strategy.
- Moving organizational economics from fee-for-service to VBC and the role of Medicare Advantage.
- The impact of new interoperability efforts and trends to enable effective PHM strategies.
The Next Revolution in Healthcare: Why the New MSSP Revisions Matter Now More...Health Catalyst
Now more than ever, we are entering a period of rapid change catalyzed by the power of data. On December 21, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program (MSSP), strengthening the financial incentives for ACOs to drive improved outcomes. The health systems that embrace data to achieve financial success will grow while the rest will struggle to compete. View this webinar for a discussion on how to prepare.
The US healthcare system didn’t develop overnight, rather, it is the culmination of a series of revolutions within wealthy parts of the world. In this webinar, we explore the high points of history that have led us to our current challenges. While care has steadily improved over time, the cost of that care has risen at a much more dramatic rate. CMS created the MSSP to help mitigate the growth of these costs while providing better care for individuals and populations. On a larger scale, the program serves to shift the healthcare industry towards fee-for-value.
Despite general frustration related to legislative involvement, history has proven that regulatory changes precede attitudinal changes and the MSSP (combined with accurate, timely data) may be just the piece of legislation to help make value-based care a reality. By viewing this webinar you will learn:
- How the US healthcare industry reached its current state.
- Why financial imperatives drive cultural change in our economic model.
- Ways that the MSSP can help your organization achieve financial success.
- Ideas for how to utilize data to develop better healthcare delivery systems.
Dr. Will Caldwell is a strong proponent of the use of data analytics to promote good health and save lives. His area of expertise rests in technology-enabled health care delivery models and value-based care platforms. We hope that you will view this webinar and learn from his 17-years of work as a data-informed clinician.
Perspectives in Commercial Health Insurance: Leveraging Information-as-a-Serv...Salus One Ed
Similar to most industries, health insurance organizations are struggling to establish cohesive views of data, defining data across the enterprise, and working with a multitude of transactional and analytical data silos. This document addresses information management complexity amongst health insurers and how information-as-a-service (IaaS) incorporates the aspects of data modeling, tightly-linked service capabilities, and viewing necessary knowledge across core platforms while establishing a loosely-coupled approach to viewing necessary decision-making data.
Population Stratification Made Easy, Quick, and Transparent for AnyoneHealth Catalyst
One of the fundamental tasks when creating a population health initiative is to identify the right patients for the right interventions. The challenge with identifying patients is two-fold—there isn’t a one-size-fits all stratification method; and, current stratification tools prove to be inflexible, “black box” solutions that require time-consuming, technical expertise to customize the algorithms. Many commonly used stratification methods also fail to take advantage of the whole-patient picture, using the limited data sources that are available.
To address these challenges, Health Catalyst developed the Population Builder™️: Stratification Module; a fast, adaptable tool that allows for rapid and transparent stratification of patient groups based on predefined, yet easy to customize, populations and then provides the architecture to integrate the stratified populations into the population health workflow.
Based on the existing Population Builder tool, the Stratification Module consists of several population health building blocks that users can mix and match to create purpose-driven, transparent, and customizable populations to fit their needs. The building blocks save users the time and effort of creating the raw materials required for effective stratification by providing industry standard, evidence-based definitions for over 6,000 value sets, 21 predefined chronic condition registries, ED utilization (combined claims and clinical data), transition of care, and predictive risk models all in one tool. In addition, the power of AI is made accessible and easy with Health Catalyst-developed risk algorithms that are targeted to specific interventions.
View the Population Builder: Stratification Module webinar to learn more about its functionality, understand the customization process, observe a unique framework that integrates claims and clinical data, and make it easy to consume customized data sources, so that your algorithms include all of your available patient data.
In this webinar you can expect to:
- Learn how Population Builder: Stratification Module is used to combine data from multiple data sources—including claims and clinical data—to stratify based on a “whole patient picture.”
- Get a glimpse of the predefined stratification content that is packaged within the Population Builder: Stratification Module.
- Understand how the Population Builder: Stratification Module allows non-technical experts to quickly and transparently create sophisticated stratification algorithms.
- See how “published” patient lists, or registries, are created within Population Builder: Stratification Module and accessible by the DOS ecosystem.
Platforms and Partnerships: The Building Blocks for Digital InnovationHealth Catalyst
Virtually all service-oriented industries have experienced massive disruption and transformation, resulting from the confluence of digital, mobile, cloud, data, and consumerization. And then there’s healthcare…
In this webinar Ryan Smith, executive advisor at Health Catalyst, shares practical insights gained from his combined 25 years of IT and digital leadership roles at Banner Health and Intermountain Healthcare. He explores why our industry is struggling to provide the tools and self-service experiences that patients and consumers have come to expect in every other aspect of their lives. To attract and retain patients and members, healthcare organizations need to “shift gears” and go on the digital offensive to sustain brand loyalty; however, decades of siloed, monolithic approaches to implementing technology and managing data continue to hamper industry progress.
During this session, Ryan shares his approach for building business support to enable digital transformation.
By viewing this webinar, you will learn key digitization concepts:
- How to conceptualize a digital enablement framework.
- Ten strategic guiding principles for technology leaders.
- Why it’s vital to create business-driven technology governance.
- Why building strategic vendor partnerships really matters.
- How to apply case studies to bolster digital investments.
hCentive Webinsure Medicare Part D & Part C PlatformAlisha North
hCentive's WebInsure Medicare is an ACA/HIPAA compliant solution. WebInsure Medicare simplifies the implementation of health reforms and provides a cost-effective, profitably-tailored solution for insurers.
This Discussion offers you the opportunity to apply return on in.docxgasciognecaren
This Discussion offers you the opportunity to apply return on investment (ROI) concepts in a real case scenario. As is often the case, technology offerings involve costs that must be justified by virtue of expense reductions for revenue increases in the organization. There are creative opportunities in the Discussion for leaders to facilitate the development of the revenues into the organization and operational changes that reduce expenses.
Scenario:
Dynamic Health System is a 3-hospital, 500-bed system in the Midwest United States. This system employs 100 physicians, both primary care and specialists, in 12 physician practices. Dynamic also runs a center of excellence in orthopedic care for the large geriatric population in the area, including an outpatient rehabilitation facility that is currently profitable. Dynamic offers a full spectrum of medical and surgical services to their population with an emphasis on programs of excellence in orthopedic surgery, diabetes, and women’s care.
Dynamic’s typical patient mix is over 45% Medicare with another 35% private pay patients covered by three large insurance companies. Their Medicaid population is approximately 12%, with the reminder of patients self-pay.
Due to market forces, the three private payers have begun to implement a program of bundled payments for their members in the following areas: hip replacements, knee replacements, and lower back surgeries. In these models, Dynamic hospitals and employed physicians will be paid a fixed amount for an entire episode of care from pre- surgery evaluation, through surgery and post-surgery, physical therapy, and rehabilitation. Medicare is likewise proposing a pilot study for a population of hip replacement beneficiaries to assess the outcomes of care as opposed to procedure costs as a result of Dynamic’s petition to receive increased payments for beneficiaries due to age demographics and for being the only orthopedic geriatric center in 200 miles.
As a result of these factors and the aging HIT infrastructure, the Chief Medical Officer (CMO), Chief Executive Officer (CEO), and Chief Information Officer (CIO) of Dynamic are proposing the purchase of a monolithic Electronic Health Record (EMR) solution that will provide complete online documentation, orders, pharmacy, labs, and patient portal for all hospitals and employed physician offices. Because the (1) physician offices are currently using Epic Corporation’s back office billing system with an outstanding record of accurate coding and short “days in Accounts Receivable” and (2) Epic’s EMR has a high ranking in industry HIT assessments, the executive team is proposing the purchase of Epic’s clinical EMR (documentation, ancillaries, orders, and patient portal).
The CFO is supportive but skeptical, as the Epic bid is approximately $1.5 M to implement the clinical software with a continued $300K per year in software maintenance and support. Current clinical technologies information systems are fra ...
The value of pre adjudication in healthcare claims processing - banc tec's wh...Jone Smith
BancTec provides Healthcare payers and benefit administrators with pre-adjudication technologies thus replacing error-prone human process and providing application for document management, PPO network management etc.
Reducing Risk, Cost and Complexity Across Healthcare Processes With the Lightwell Healthcare B2B Gateway. The Lightwell Healthcare B2B Gateway solution helps healthcare organizations address HIPAA requirements (levels 1-7) while reducing risk, cost and complexity across their B2B processes.
Cutthroat competition and high regulation is squeezing bottom-lines of insurance companies. Moreover, if the claims processing is slow and document management is not seamless, the profits can dwindle further. One way to offset these impediments is to modernize claims processing and document management by collaborating with companies having deep domain expertise in these areas. HCL shows how this can be achieved.
Independent consultant since 1996 with over 30 years of experience with Healthcare Information Systems; Expertise in healthcare industry, project management, business analysis, business administration/operations, Electronic Data Interchange (EDI), Electronic Medical Record (EMR), Physician Practice Management (PM), Health Information Exchange (HIE), testing, training, support and consulting; Experience working directly with providers, payers, software manufacturers, electronic data interchange organizations, billing services, clearinghouses and government agencies; Excellent skills for communication, technical research and problem-solving. Efficient and effective leadership for cost effective solutions.
These slides are the property of Chilmark Research and have been published with their permission.
-
Population Health Management (PHM) has been in the health IT lexicon for nearly a decade, yet the industry still lacks a clear definition of how provider organizations extract value from their PHM initiatives. Part of the problem is that PHM is often defined as a technology solution when it, in fact, is not. Rather, PHM is a technology-enabled strategy that includes a multitude of capabilities (e.g., interoperability, analytics, care management, engagement, etc.) and services. Secondly, an organization adopts a PHM strategy to support its value-based care (VBC) contracts, but VBC remains an elusive target that is highly dependent on local and regional conditions.
In this presentation, John Moore briefly walks through the evolution of the PHM market and its increasingly integral tie to VBC and future technology and market trajectories. Highlighted topics include EHR versus best-of-breed solutions, FHIR and open APIs, and the increasing role of IT-enabled services.
Learning Objectives:
- Reframing PHM: Defining PHM as a strategy, not a product.
- Core elements of a technology-enabled PHM strategy.
- Moving organizational economics from fee-for-service to VBC and the role of Medicare Advantage.
- The impact of new interoperability efforts and trends to enable effective PHM strategies.
The Next Revolution in Healthcare: Why the New MSSP Revisions Matter Now More...Health Catalyst
Now more than ever, we are entering a period of rapid change catalyzed by the power of data. On December 21, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program (MSSP), strengthening the financial incentives for ACOs to drive improved outcomes. The health systems that embrace data to achieve financial success will grow while the rest will struggle to compete. View this webinar for a discussion on how to prepare.
The US healthcare system didn’t develop overnight, rather, it is the culmination of a series of revolutions within wealthy parts of the world. In this webinar, we explore the high points of history that have led us to our current challenges. While care has steadily improved over time, the cost of that care has risen at a much more dramatic rate. CMS created the MSSP to help mitigate the growth of these costs while providing better care for individuals and populations. On a larger scale, the program serves to shift the healthcare industry towards fee-for-value.
Despite general frustration related to legislative involvement, history has proven that regulatory changes precede attitudinal changes and the MSSP (combined with accurate, timely data) may be just the piece of legislation to help make value-based care a reality. By viewing this webinar you will learn:
- How the US healthcare industry reached its current state.
- Why financial imperatives drive cultural change in our economic model.
- Ways that the MSSP can help your organization achieve financial success.
- Ideas for how to utilize data to develop better healthcare delivery systems.
Dr. Will Caldwell is a strong proponent of the use of data analytics to promote good health and save lives. His area of expertise rests in technology-enabled health care delivery models and value-based care platforms. We hope that you will view this webinar and learn from his 17-years of work as a data-informed clinician.
Perspectives in Commercial Health Insurance: Leveraging Information-as-a-Serv...Salus One Ed
Similar to most industries, health insurance organizations are struggling to establish cohesive views of data, defining data across the enterprise, and working with a multitude of transactional and analytical data silos. This document addresses information management complexity amongst health insurers and how information-as-a-service (IaaS) incorporates the aspects of data modeling, tightly-linked service capabilities, and viewing necessary knowledge across core platforms while establishing a loosely-coupled approach to viewing necessary decision-making data.
Population Stratification Made Easy, Quick, and Transparent for AnyoneHealth Catalyst
One of the fundamental tasks when creating a population health initiative is to identify the right patients for the right interventions. The challenge with identifying patients is two-fold—there isn’t a one-size-fits all stratification method; and, current stratification tools prove to be inflexible, “black box” solutions that require time-consuming, technical expertise to customize the algorithms. Many commonly used stratification methods also fail to take advantage of the whole-patient picture, using the limited data sources that are available.
To address these challenges, Health Catalyst developed the Population Builder™️: Stratification Module; a fast, adaptable tool that allows for rapid and transparent stratification of patient groups based on predefined, yet easy to customize, populations and then provides the architecture to integrate the stratified populations into the population health workflow.
Based on the existing Population Builder tool, the Stratification Module consists of several population health building blocks that users can mix and match to create purpose-driven, transparent, and customizable populations to fit their needs. The building blocks save users the time and effort of creating the raw materials required for effective stratification by providing industry standard, evidence-based definitions for over 6,000 value sets, 21 predefined chronic condition registries, ED utilization (combined claims and clinical data), transition of care, and predictive risk models all in one tool. In addition, the power of AI is made accessible and easy with Health Catalyst-developed risk algorithms that are targeted to specific interventions.
View the Population Builder: Stratification Module webinar to learn more about its functionality, understand the customization process, observe a unique framework that integrates claims and clinical data, and make it easy to consume customized data sources, so that your algorithms include all of your available patient data.
In this webinar you can expect to:
- Learn how Population Builder: Stratification Module is used to combine data from multiple data sources—including claims and clinical data—to stratify based on a “whole patient picture.”
- Get a glimpse of the predefined stratification content that is packaged within the Population Builder: Stratification Module.
- Understand how the Population Builder: Stratification Module allows non-technical experts to quickly and transparently create sophisticated stratification algorithms.
- See how “published” patient lists, or registries, are created within Population Builder: Stratification Module and accessible by the DOS ecosystem.
Platforms and Partnerships: The Building Blocks for Digital InnovationHealth Catalyst
Virtually all service-oriented industries have experienced massive disruption and transformation, resulting from the confluence of digital, mobile, cloud, data, and consumerization. And then there’s healthcare…
In this webinar Ryan Smith, executive advisor at Health Catalyst, shares practical insights gained from his combined 25 years of IT and digital leadership roles at Banner Health and Intermountain Healthcare. He explores why our industry is struggling to provide the tools and self-service experiences that patients and consumers have come to expect in every other aspect of their lives. To attract and retain patients and members, healthcare organizations need to “shift gears” and go on the digital offensive to sustain brand loyalty; however, decades of siloed, monolithic approaches to implementing technology and managing data continue to hamper industry progress.
During this session, Ryan shares his approach for building business support to enable digital transformation.
By viewing this webinar, you will learn key digitization concepts:
- How to conceptualize a digital enablement framework.
- Ten strategic guiding principles for technology leaders.
- Why it’s vital to create business-driven technology governance.
- Why building strategic vendor partnerships really matters.
- How to apply case studies to bolster digital investments.
hCentive Webinsure Medicare Part D & Part C PlatformAlisha North
hCentive's WebInsure Medicare is an ACA/HIPAA compliant solution. WebInsure Medicare simplifies the implementation of health reforms and provides a cost-effective, profitably-tailored solution for insurers.
This Discussion offers you the opportunity to apply return on in.docxgasciognecaren
This Discussion offers you the opportunity to apply return on investment (ROI) concepts in a real case scenario. As is often the case, technology offerings involve costs that must be justified by virtue of expense reductions for revenue increases in the organization. There are creative opportunities in the Discussion for leaders to facilitate the development of the revenues into the organization and operational changes that reduce expenses.
Scenario:
Dynamic Health System is a 3-hospital, 500-bed system in the Midwest United States. This system employs 100 physicians, both primary care and specialists, in 12 physician practices. Dynamic also runs a center of excellence in orthopedic care for the large geriatric population in the area, including an outpatient rehabilitation facility that is currently profitable. Dynamic offers a full spectrum of medical and surgical services to their population with an emphasis on programs of excellence in orthopedic surgery, diabetes, and women’s care.
Dynamic’s typical patient mix is over 45% Medicare with another 35% private pay patients covered by three large insurance companies. Their Medicaid population is approximately 12%, with the reminder of patients self-pay.
Due to market forces, the three private payers have begun to implement a program of bundled payments for their members in the following areas: hip replacements, knee replacements, and lower back surgeries. In these models, Dynamic hospitals and employed physicians will be paid a fixed amount for an entire episode of care from pre- surgery evaluation, through surgery and post-surgery, physical therapy, and rehabilitation. Medicare is likewise proposing a pilot study for a population of hip replacement beneficiaries to assess the outcomes of care as opposed to procedure costs as a result of Dynamic’s petition to receive increased payments for beneficiaries due to age demographics and for being the only orthopedic geriatric center in 200 miles.
As a result of these factors and the aging HIT infrastructure, the Chief Medical Officer (CMO), Chief Executive Officer (CEO), and Chief Information Officer (CIO) of Dynamic are proposing the purchase of a monolithic Electronic Health Record (EMR) solution that will provide complete online documentation, orders, pharmacy, labs, and patient portal for all hospitals and employed physician offices. Because the (1) physician offices are currently using Epic Corporation’s back office billing system with an outstanding record of accurate coding and short “days in Accounts Receivable” and (2) Epic’s EMR has a high ranking in industry HIT assessments, the executive team is proposing the purchase of Epic’s clinical EMR (documentation, ancillaries, orders, and patient portal).
The CFO is supportive but skeptical, as the Epic bid is approximately $1.5 M to implement the clinical software with a continued $300K per year in software maintenance and support. Current clinical technologies information systems are fra ...
You are an information technology (IT) intern working for Health N.docxavaforman16457
You are an information technology (IT) intern working for Health Network, Inc. (Health Network), a fictitious health services organization headquartered in Minneapolis, Minnesota. Health Network has over 600 employees throughout the organization and generates $500 million USD in annual revenue. The company has two additional locations in Portland, Oregon and Arlington, Virginia, which support a mix of corporate operations. Each corporate facility is located near a co-location data center, where production systems are located and managed by third-party data center hosting vendors.
Company Products
Health Network has three main products: HNetExchange, HNetPay, and HNetConnect.
HNetExchange is the primary source of revenue for the company. The service handles secure electronic medical messages that originate from its customers, such as large hospitals, which are then routed to receiving customers such as clinics.
HNetPay is a Web portal used by many of the company’s HNetExchange customers to support the management of secure payments and billing. The HNetPay Web portal, hosted at Health Network production sites, accepts various forms of payments and interacts with credit-card processing organizations much like a Web commerce shopping cart.
HNetConnect is an online directory that lists doctors, clinics, and other medical facilities to allow Health Network customers to find the right type of care at the right locations. It contains doctors’ personal information, work addresses, medical certifications, and types of services that the doctors and clinics offer. Doctors are given credentials and are able to update the information in their profile. Health Network customers, which are the hospitals and clinics, connect to all three of the company’s products using HTTPS connections. Doctors and potential patients are able to make payments and update their profiles using Internet-accessible HTTPS Web sites.
NOTE: Any discussion of products not a part of this scenario, such as health insurance products, will result in an automatic 50% reduction in points. Your paper is not a research paper on risk management – it is a risk management plan to a very specific situation and must relate to the scenario, above.
Information Technology Infrastructure Overview
Health Network operates in three production data centers that provide high availability across the company’s products. The data centers host about 1,000 production servers, and Health Network maintains 650 corporate laptops and company-issued mobile devices for its employees.
Threats Identified
Upon review of the current risk management plan, the following threats were identified:
· Loss of company data due to hardware being removed from production systems
· Loss of company information on lost or stolen company-owned assets, such as mobile devices and laptops
· Loss of customers due to production outages caused by various events, such as natural disasters, change management, unstable software, and so on
·.
Project: Risk Management Plan
Purpose
This project provides an opportunity to apply the competencies gained in the lessons of this course to develop a risk management plan for a fictitious organization to replace its outdated plan.
Learning Objectives and Outcomes
You will gain an overall understanding of risk management, its importance, and critical processes required when developing a formal risk management plan for an organization.
Required Source Information and Tools
Web References: Links to Web references in this document and related materials are subject to change without prior notice. These links were last verified on April 19, 2015.
The following tools and resources that will be needed to complete this project:
· Course textbook
· Internet access for research
Deliverables
As discussed in this course, risk management is an important process for all organizations. This is particularly true in information systems, which provides critical support for organizational missions. The heart of risk management is a formal risk management plan. The project activities described in this document allow you to fulfill the role of an employee participating in the risk management process in a specific business situation.
The project is structured as follows:
Project Part
Deliverable
Project Part 1
Task 1: Risk Management Plan – Due 2/19
Submission Requirements
All project submissions should follow this format:
· Format: Microsoft Word or compatible
· Font: Arial, 10-point, double-space
· Citation Style: Your school’s preferred style guide
Scenario
You are an information technology (IT) intern working for Health Network, Inc. (Health Network), a fictitious health services organization headquartered in Minneapolis, Minnesota. Health Network has over 600 employees throughout the organization and generates $500 million USD in annual revenue. The company has two additional locations in Portland, Oregon and Arlington, Virginia, which support a mix of corporate operations. Each corporate facility is located near a co-location data center, where production systems are located and managed by third-party data center hosting vendors.
Company Products
Health Network has three main products: HNetExchange, HNetPay, and HNetConnect.
HNetExchange is the primary source of revenue for the company. The service handles secure electronic medical messages that originate from its customers, such as large hospitals, which are then routed to receiving customers such as clinics.
HNetPay is a Web portal used by many of the company’s HNetExchange customers to support the management of secure payments and billing. The HNetPay Web portal, hosted at Health Network production sites, accepts various forms of payments and interacts with credit-card processing organizations much like a Web commerce shopping cart.
HNetConnect is an online directory that lists doctors, clinics, and other medical facilities to allow Health Network customers to find the right type of care at the righ ...
You are an information technology (IT) intern working for Health.docxavaforman16457
You are an information technology (IT) intern working for Health Network, Inc. (Health Network), a fictitious health services organization headquartered in Minneapolis, Minnesota. Health Network has over 600 employees throughout the organization and generates $500 million USD in annual revenue. The company has two additional locations in Portland, Oregon and Arlington, Virginia, which support a mix of corporate operations. Each corporate facility is located near a co-location data center, where production systems are located and managed by third-party data center hosting vendors.
Company Products
Health Network has three main products:
HNetExchange
,
HNetPay
, and
HNetConnect.
HNetExchange is the primary source of revenue for the company. The service handles secure electronic medical messages that originate from its customers, such as large hospitals, which are then routed to receiving customers such as clinics.
HNetPay is a Web portal used by many of the company’s HNetExchange customers to support the management of secure payments and billing. The HNetPay Web portal, hosted at Health Network production sites, accepts various forms of payments and interacts with credit-card processing organizations much like a Web commerce shopping cart.
HNetConnect is an online directory that lists doctors, clinics, and other medical facilities to allow Health Network customers to find the right type of care at the right locations. It contains doctors’ personal information, work addresses, medical certifications, and types of services that the doctors and clinics offer. Doctors are given credentials and are able to update the information in their profile. Health Network customers, which are the hospitals and clinics, connect to all three of the company’s products using HTTPS connections. Doctors and potential patients are able to make payments and update their profiles using Internet-accessible HTTPS Web sites.
NOTE:
Any discussion of products not a part of this scenario, such as health insurance products, will result in an automatic 50% reduction in points. Your paper
is not a research paper on risk management – it is a risk management plan to a very specific situation and must relate to the scenario, above.
Information Technology Infrastructure Overview
Health Network operates in three production data centers that provide high availability across the company’s products. The data centers host about 1,000 production servers, and Health Network maintains 650 corporate laptops and company-issued mobile devices for its employees.
Threats Identified
Upon review of the current risk management plan, the following threats were identified:
· Loss of company data due to hardware being removed from production systems
· Loss of company information on lost or stolen company-owned assets, such as mobile devices and laptops
· Loss of customers due to production outages caused by various events, such as natural disasters, change management, unstable sof.
EHR Integration: Achieving this Digital Health ImperativeHealth Catalyst
As the digital trajectory of healthcare rises, health systems have an array of new resources available to make more effective and timely care decisions. However, to use these data analytics, machine learning, predictive analytics, and wellness applications to gain real-time, data-driven insight at the point of care, health systems must fully integrate the tools with their EHRs. Integration brings technical and administrative challenges, requiring organizations to coordinate around standards, administrative processes, regulatory principles, and functional integration, as well as develop compelling integration use cases that drive demand. When realized, full EHR integration will allow clinicians to leverage data from across the continuum of care (from health plan to patient-generated data) to improve patient diagnosis and treatment.
Project: Risk Management Plan
Purpose
This project provides an opportunity to apply the competencies gained in the lessons of this course to develop a risk management plan for a fictitious organization to replace its outdated plan.
Learning Objectives and Outcomes
You will gain an overall understanding of risk management, its importance, and critical processes required when developing a formal risk management plan for an organization.
Required Source Information and Tools
Web References: Links to Web references in this document and related materials are subject to change without prior notice. These links were last verified on April 19, 2015.
The following tools and resources that will be needed to complete this project:
· Course textbook
· Internet access for research
Deliverables
As discussed in this course, risk management is an important process for all organizations. This is particularly true in information systems, which provides critical support for organizational missions. The heart of risk management is a formal risk management plan. The project activities described in this document allow you to fulfill the role of an employee participating in the risk management process in a specific business situation.
The project is structured as follows:
Project Part
Deliverable
Project Part 1
Task 1: Risk Management Plan – Due 2/19
Submission Requirements
All project submissions should follow this format:
· Format: Microsoft Word or compatible
· Font: Arial, 10-point, double-space
· Citation Style: Your school’s preferred style guide
Scenario
You are an information technology (IT) intern working for Health Network, Inc. (Health Network), a fictitious health services organization headquartered in Minneapolis, Minnesota. Health Network has over 600 employees throughout the organization and generates $500 million USD in annual revenue. The company has two additional locations in Portland, Oregon and Arlington, Virginia, which support a mix of corporate operations. Each corporate facility is located near a co-location data center, where production systems are located and managed by third-party data center hosting vendors.
Company Products
Health Network has three main products: HNetExchange, HNetPay, and HNetConnect.
HNetExchange is the primary source of revenue for the company. The service handles secure electronic medical messages that originate from its customers, such as large hospitals, which are then routed to receiving customers such as clinics.
HNetPay is a Web portal used by many of the company’s HNetExchange customers to support the management of secure payments and billing. The HNetPay Web portal, hosted at Health Network production sites, accepts various forms of payments and interacts with credit-card processing organizations much like a Web commerce shopping cart.
HNetConnect is an online directory that lists doctors, clinics, and other medical facilities to allow Health Network customers to find the right type of care at the righ.
Project Task Risk Management PlanFor the first part of the adavieec5f
Project Task : Risk Management Plan
For the first part of the assigned project, you must create an initial draft of the final risk management plan. You Risk Management Plan will contain the following sections:
A section titled Introduction discussing the purpose of the plan. You must include details from the scenario, above, describing the environment. 30 points.
A section titled Scope discussing the scope of the plan. 30 points
A section, titled Compliance Laws and Regulations. Using the information in the scenario provided above, discuss regulations and laws with which Health Network must comply. 50 points
A section, titled Roles and Responsibilities, that will discuss the different individuals and departments who will be responsible for risk management within the organization (this was presented in your textbook). 50 points
A section, titled Risk Mitigation Plan, that discusses the threats identified in the scenario and your proposed mitigations, as well as any new threats.45 points.
Write an initial draft of the risk management plan as detailed in the instructions above. Your plan should be made using a standard word processor format compatible with Microsoft Word.
Purpose: This project provides an opportunity to apply the competencies gained in the lessons of this course to develop a risk management plan for a fictitious organization to replace its outdated plan.
Required Source Information and Tools:
The following tools and resources that will be needed to complete this project:
Course textbook
Internet access for research
Deliverables:
As discussed in this course, risk management is an important process for all organizations. This is particularly true in information systems, which provides critical support for organizational missions. The heart of risk management is a formal risk management plan. The project activities described in this document allow you to fulfill the role of an employee participating in the risk management process in a specific business situation.
The project is structured as follows:
Project Part Deliverable
Project Part 1 Task 1: Risk Management Plan – Due 4/15
Submission Requirements:
All project submissions should follow this format:
Format: Microsoft Word or compatible
Font: Arial, 10-point, double-space
Citation Style: Your school’s preferred style guide
Scenario:
You are an information technology (IT) intern working for Health Network, Inc. (Health Network), a fictitious health services organization headquartered in Minneapolis, Minnesota. Health Network has over 600 employees throughout the organization and generates $500 million USD in annual revenue. The company has two additional locations in Portland, Oregon and Arlington, Virginia, which support a mix of corporate operations. Each corporate facility is located near a co-location data center, where production systems are located and managed by third-party data center hosting vendors.
Company Products :
...
The eligibility and enrollment procedure for our clients is managed by Vee Technologies' trained team of subject matter experts, which includes the verification and determination of each member's coverage specificity. By delegating this duty to Vee Technologies, your company will be able to focus on vital business responsibilities that will improve internal processes.
Visit: https://tinyurl.com/27xtmbry
A community health plan with 200,000 members converted to an automated, data-driven cost containment platform for coordination of benefits, subrogation, and MSP validation and premium restoration. Within 15 months, the company recovered more than $11 million. The company continues to work with Discovery Health Partners' Intelligent Cost Containment Platform and savings continue to grow.
Submission Requirementsproject submissions should follow th.docxdavid4611
Submission Requirements
project submissions should follow this format:
Format: Microsoft Word or compatible
Font: Arial, 10-point, double-space
References must be included
Minimum 2 pages
Scenario
You are an information technology (IT) intern working for Health Network, Inc. (Health Network), a fictitious health services organization headquartered in Minneapolis, Minnesota. Health Network has over 600 employees throughout the organization and generates $500 million USD in annual revenue. The company has two additional locations in Portland, Oregon and Arlington, Virginia, which support a mix of corporate operations. Each corporate facility is located near a co-location data center, where production systems are located and managed by third-party data center hosting vendors.
Company Products
Health Network has three main products: HNetExchange, HNetPay, and HNetConnect.
HNetExchange is the primary source of revenue for the company. The service handles secure electronic medical messages that originate from its customers, such as large hospitals, which are then routed to receiving customers such as clinics.
HNetPay is a Web portal used by many of the company’s HNetExchange customers to support the management of secure payments and billing. The HNetPay Web portal, hosted at Health Network production sites, accepts various forms of payments and interacts with credit-card processing organizations much like a Web commerce shopping cart.
HNetConnect is an online directory that lists doctors, clinics, and other medical facilities to allow Health Network customers to find the right type of care at the right locations. It contains doctors’ personal information, work addresses, medical certifications, and types of services that the doctors and clinics offer. Doctors are given credentials and are able to update the information in their profile. Health Network customers, which are the hospitals and clinics, connect to all three of the company’s products using HTTPS connections. Doctors and potential patients are able to make payments and update their profiles using Internet-accessible HTTPS Web sites.
Information Technology Infrastructure Overview
Health Network operates in three production data centers that provide high availability across the company’s products. The data centers host about 1,000 production servers, and Health Network maintains 650 corporate laptops and company-issued mobile devices for its employees.
Threats Identified
Upon review of the current risk management plan, the following threats were identified:
· Loss of company data due to hardware being removed from production systems
· Loss of company information on lost or stolen company-owned assets, such as mobile devices and laptops
· Loss of customers due to production outages caused by various events, such as natural disasters, change management, unstable software, and so on
· Internet threats due to company products being accessi.
Obamacare markets debut as early hurdles may slow signups - hCentive newsAlisha North
The three-year effort to open the Obamacare health-insurance exchanges culminates today, beset by logistical delays and a U.S. government shutdown borne of Republican opposition to the Affordable Care Act.
Obamacare crashes onths in coming not easily repaired - hCentive newsAlisha North
In the weeks before the start of Obamacare, officials failed to complete exhaustive testing of the program’s website in a push to begin signups by Oct. 1, according to people involved in the rollout.
Back end errors at u.s. health website jeopardize sign-up-hCentive newsAlisha North
There’s no way to tell how many people who think they enrolled for health insurance through the U.S. Obamacare exchange actually have, after about 1 in 4 files sent to insurers had garbled and incomplete information.
6 fields where obamacare is creating jobs- hCentive newsAlisha North
Increasingly, it's a technology-driven world, and health care is no exception. Those who work at the intersection between health care and information technology say the Affordable Care Act will only bring the two fields even closer.
hCentive Health Insurance Exchange PlatformAlisha North
Take advantage of hCentive's deep expertise in the healthcare insurance industry. Browse through or download our white papers to get an in-depth understanding of the industry.
State of ICS and IoT Cyber Threat Landscape Report 2024 previewPrayukth K V
The IoT and OT threat landscape report has been prepared by the Threat Research Team at Sectrio using data from Sectrio, cyber threat intelligence farming facilities spread across over 85 cities around the world. In addition, Sectrio also runs AI-based advanced threat and payload engagement facilities that serve as sinks to attract and engage sophisticated threat actors, and newer malware including new variants and latent threats that are at an earlier stage of development.
The latest edition of the OT/ICS and IoT security Threat Landscape Report 2024 also covers:
State of global ICS asset and network exposure
Sectoral targets and attacks as well as the cost of ransom
Global APT activity, AI usage, actor and tactic profiles, and implications
Rise in volumes of AI-powered cyberattacks
Major cyber events in 2024
Malware and malicious payload trends
Cyberattack types and targets
Vulnerability exploit attempts on CVEs
Attacks on counties – USA
Expansion of bot farms – how, where, and why
In-depth analysis of the cyber threat landscape across North America, South America, Europe, APAC, and the Middle East
Why are attacks on smart factories rising?
Cyber risk predictions
Axis of attacks – Europe
Systemic attacks in the Middle East
Download the full report from here:
https://sectrio.com/resources/ot-threat-landscape-reports/sectrio-releases-ot-ics-and-iot-security-threat-landscape-report-2024/
Smart TV Buyer Insights Survey 2024 by 91mobiles.pdf91mobiles
91mobiles recently conducted a Smart TV Buyer Insights Survey in which we asked over 3,000 respondents about the TV they own, aspects they look at on a new TV, and their TV buying preferences.
Dev Dives: Train smarter, not harder – active learning and UiPath LLMs for do...UiPathCommunity
💥 Speed, accuracy, and scaling – discover the superpowers of GenAI in action with UiPath Document Understanding and Communications Mining™:
See how to accelerate model training and optimize model performance with active learning
Learn about the latest enhancements to out-of-the-box document processing – with little to no training required
Get an exclusive demo of the new family of UiPath LLMs – GenAI models specialized for processing different types of documents and messages
This is a hands-on session specifically designed for automation developers and AI enthusiasts seeking to enhance their knowledge in leveraging the latest intelligent document processing capabilities offered by UiPath.
Speakers:
👨🏫 Andras Palfi, Senior Product Manager, UiPath
👩🏫 Lenka Dulovicova, Product Program Manager, UiPath
Software Delivery At the Speed of AI: Inflectra Invests In AI-Powered QualityInflectra
In this insightful webinar, Inflectra explores how artificial intelligence (AI) is transforming software development and testing. Discover how AI-powered tools are revolutionizing every stage of the software development lifecycle (SDLC), from design and prototyping to testing, deployment, and monitoring.
Learn about:
• The Future of Testing: How AI is shifting testing towards verification, analysis, and higher-level skills, while reducing repetitive tasks.
• Test Automation: How AI-powered test case generation, optimization, and self-healing tests are making testing more efficient and effective.
• Visual Testing: Explore the emerging capabilities of AI in visual testing and how it's set to revolutionize UI verification.
• Inflectra's AI Solutions: See demonstrations of Inflectra's cutting-edge AI tools like the ChatGPT plugin and Azure Open AI platform, designed to streamline your testing process.
Whether you're a developer, tester, or QA professional, this webinar will give you valuable insights into how AI is shaping the future of software delivery.
Key Trends Shaping the Future of Infrastructure.pdfCheryl Hung
Keynote at DIGIT West Expo, Glasgow on 29 May 2024.
Cheryl Hung, ochery.com
Sr Director, Infrastructure Ecosystem, Arm.
The key trends across hardware, cloud and open-source; exploring how these areas are likely to mature and develop over the short and long-term, and then considering how organisations can position themselves to adapt and thrive.
Generating a custom Ruby SDK for your web service or Rails API using Smithyg2nightmarescribd
Have you ever wanted a Ruby client API to communicate with your web service? Smithy is a protocol-agnostic language for defining services and SDKs. Smithy Ruby is an implementation of Smithy that generates a Ruby SDK using a Smithy model. In this talk, we will explore Smithy and Smithy Ruby to learn how to generate custom feature-rich SDKs that can communicate with any web service, such as a Rails JSON API.
UiPath Test Automation using UiPath Test Suite series, part 4DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 4. In this session, we will cover Test Manager overview along with SAP heatmap.
The UiPath Test Manager overview with SAP heatmap webinar offers a concise yet comprehensive exploration of the role of a Test Manager within SAP environments, coupled with the utilization of heatmaps for effective testing strategies.
Participants will gain insights into the responsibilities, challenges, and best practices associated with test management in SAP projects. Additionally, the webinar delves into the significance of heatmaps as a visual aid for identifying testing priorities, areas of risk, and resource allocation within SAP landscapes. Through this session, attendees can expect to enhance their understanding of test management principles while learning practical approaches to optimize testing processes in SAP environments using heatmap visualization techniques
What will you get from this session?
1. Insights into SAP testing best practices
2. Heatmap utilization for testing
3. Optimization of testing processes
4. Demo
Topics covered:
Execution from the test manager
Orchestrator execution result
Defect reporting
SAP heatmap example with demo
Speaker:
Deepak Rai, Automation Practice Lead, Boundaryless Group and UiPath MVP
Connector Corner: Automate dynamic content and events by pushing a buttonDianaGray10
Here is something new! In our next Connector Corner webinar, we will demonstrate how you can use a single workflow to:
Create a campaign using Mailchimp with merge tags/fields
Send an interactive Slack channel message (using buttons)
Have the message received by managers and peers along with a test email for review
But there’s more:
In a second workflow supporting the same use case, you’ll see:
Your campaign sent to target colleagues for approval
If the “Approve” button is clicked, a Jira/Zendesk ticket is created for the marketing design team
But—if the “Reject” button is pushed, colleagues will be alerted via Slack message
Join us to learn more about this new, human-in-the-loop capability, brought to you by Integration Service connectors.
And...
Speakers:
Akshay Agnihotri, Product Manager
Charlie Greenberg, Host
Elevating Tactical DDD Patterns Through Object CalisthenicsDorra BARTAGUIZ
After immersing yourself in the blue book and its red counterpart, attending DDD-focused conferences, and applying tactical patterns, you're left with a crucial question: How do I ensure my design is effective? Tactical patterns within Domain-Driven Design (DDD) serve as guiding principles for creating clear and manageable domain models. However, achieving success with these patterns requires additional guidance. Interestingly, we've observed that a set of constraints initially designed for training purposes remarkably aligns with effective pattern implementation, offering a more ‘mechanical’ approach. Let's explore together how Object Calisthenics can elevate the design of your tactical DDD patterns, offering concrete help for those venturing into DDD for the first time!
UiPath Test Automation using UiPath Test Suite series, part 3DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 3. In this session, we will cover desktop automation along with UI automation.
Topics covered:
UI automation Introduction,
UI automation Sample
Desktop automation flow
Pradeep Chinnala, Senior Consultant Automation Developer @WonderBotz and UiPath MVP
Deepak Rai, Automation Practice Lead, Boundaryless Group and UiPath MVP
UiPath Test Automation using UiPath Test Suite series, part 3
hCentive Webinsure Exchange Integration Platform
1. hCentiv e
Technology Solutions to Simplify Healthcare
WebInsure Exchange Manager
“Solution to Exchange Integration”
Are you an insurer worried about integrating to state & federal
exchanges? Are you worried about cost, technology
infrastructure, strategy, complexity and deadlines?
This white paper addresses these concerns and more. Learn
what steps you need to take and what pitfalls to avoid. Let
hCentive be your guide through this challenging and
changing landscape.
This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in
whole or in part—for any purpose other than to evaluate hCentive products or services. This document
contains con�dential and proprietary information specific to hCentive, Inc.
2. hCentive
Technology Solutions to Simplify Healthcare
Health Insurance Exchange Integration
Introduction
The Supreme Court ruling on health reform, released June 28, 2012, upheld the two key elements of the
health coverage or pay a penalty; and the massive nationwide Medicaid eligibility expansion, which will
extend health coverage to a broader segment of the U.S. population. The U.S. Census Bureau reports that there
are approximately 50.7 million uninsured Americans, including 8.7 million children. In the near future, it is
According to the healthcare reform, states need to have a Health Insurance Exchange (HIX) operational by
Oct. 1, 2013. To comply and take advantage of the opportunity, insurers need to integrate and showcase their
products across multiple state exchanges. This integration requires insurers to conform to various PPACA and
rollments, life status change requests, billing and many others.
Individual
Business
Services
Education and
Customer Service
Eligibility
Determination
Health
Plan
Technical
Infrastructure
Customer Services
Customer Relationship
Management Systems
Coverage Rating
and Quoting
Broker
Product & Benefits
Enrollment
and Renewal
Enrollment & Billing
Premium Billing/
Reconciliation
Small Group
(SHOP)
Member
Management
Membership, Billing
and other Systems
General Ledger
Member
Management
Data Warehouse
Currently, insurers work directly with individuals, brokers, and small groups (aka Small Business Health
Options Programs or SHOP). Therefore, their processes aren’t equipped to integrate with HIX. These processes
include customer service, eligibility determination, coverage rating, enrollment, renewal, billing,
reconciliation, member management and more. Compounding the problem, the majority of these processes
are supported by proprietary technical infrastructures, which can make integration incredibly difficult.
This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in whole or in part—for any
purpose other than to evaluate hCentive products or services. This document contains con dential and proprietary information specific to
hCentive, Inc.
1
3. hCentive
Technology Solutions to Simplify Healthcare
infrastructures, which payers do not know if their systems can support.
systems and
Unfortunately despite PPACA’s aggressive deadlines, many organizations and agencies have had a “wait and
see” attitude and have not taken any meaningful action.
Evolve with the Change or Wither Away?
integrate with the newly founded HIX in order to enroll subscribers. If they choose not to integrate with HIX,
and, most likely, see a decrease in market share.
If they integrate poorly with HIX, they could significantly increase internal costs and offset newly found
revenue.
This new landscape is forcing insurers to transform but they are struggling with what exactly that means. This
Business
Services
Technical
Infrastructure
Customer Services
Customer Relationship
Management Systems
Education and
Customer Service
Eligibility
Determination
Individual
Small Group
(SHOP)
Coverage Rating
and Quoting
Enrollment
and Renewal
Coverage Rating
and Quoting
Premium Billing/
Reconciliation
Product & Benefits
Member
Management
Enrollment & Billing
Customer Service
Member
Management
Enrollment
and Renewal
Premium Billing/
Reconciliation
Health
Insurance
Exchange
(HIX)
Member
Management
Health
Plan
Membership, Billing
and other Systems
General Ledger
Data Warehouse
Subsidy Reconciliation
Self Service Capabilities
Federal Agencies
Bill, Pay, Delinquency and Customer Service
Individual
Consumer
This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in whole or in part—for any
purpose other than to evaluate hCentive products or services. This document contains con dential and proprietary information specific to
hCentive, Inc.
2
4. hCent ive
Technology Solutions to Simplify Healthcare
Implementation Readiness
Insurers need to realign their organizational governance to prepare for the reform. A roadmap needs to be
Operational and Technical Readiness
can avoid extensive costs and not unnecessarily tax resources. Integration with multiple HIX requires a new
technical infrastructure. Insurers must be equipped with an automated backend system that seamlessly works
with state HIX for eligibility, enrollment, billing and reconciliation transactions. This is a step that many
organizations had put on hold and are now scrambling to put a plan in place.
Exchange Management and Connectivity Solution
hCentive’s WebInsure Exchange Manager (WEM) can lift the burden of adapting to this new landscape. It acts
as an integration point between HIX, your organization and other related parties to minimize the impact on
existing business services and technical infrastructures.
This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in whole or in part—for any
purpose other than to evaluate hCentive products or services. This document contains confidential and proprietary information specific to
hCentive, Inc.
3
5. hCentive
Technology Solutions to Simplify Healthcare
End-to-End Processing
hCentive’s End-to-End Business Service and Technology Solution provides the operational and technology
components for a health plan to interact with state HIX and federal and state entities, and members/groups.
It includes the following features:
1. Enrollment/Renewal and Payments
a. Collect enrollment information in a variety of formats, such as 834x12, 834 4010 v220, 834
5010 v307, custom XML format, mainframe formats, etc.
b. Collect billing information and calculate premium
2. Customer Service
a.
b. Allow searching of enrollments using HIX, payer member IDs and other
3. Plan Management & Distribution
a.
b. Integrate with HIOS and SERFF as required
c.
4. Reconcile Enrollments and Membership
5. Premium Billing and Reconciliation
a. Provide the ability to generate and distribute invoices, accept online payments, post
payments, manage delinquency and reconcile payments
b. Provide subsidy reconciliation
6. Member Management
a. Collect and process updates, terminations and re-instatements requests
hCentive’s solution will guide your organization to quickly adapt to the changes that are imminent
due to the reform.
This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in whole or in part—for any
purpose other than to evaluate hCentive products or services. This document contains con dential and proprietary information specific to
hCentive, Inc.
4
6. hCentive
Technology Solutions to Simplify Healthcare
Get Organized, Get Started
new Exchange model. This involves a readiness assessment and road map, gap analysis, requirements
steps.
Solution Integration
WEM acts as a middleware, integrating HIX and your organization's backend systems in the most seamless way
possible. This allows you to seamlessly integrate existing business services, including revenue reporting,
enrollment management, reconciliati on, plan management, customer service and more.
While it is necessary for an exchange solution to be able to connect with multiple HIX, it isn’t going to be easy.
Since there aren’t set standards and protocols, it is highly probable that various states’ HIX will not speak same
language. The exchange format and protocol will most likely vary from state to state and organization to
organization. This is why hCentive developed WebInsure Exchange Manager to be input/output (I/O)
agnostic. Due to WEM’s I/O agnostic nature, your organization’s technical infrastructure does not need to
existing infrastructure and various health insurance exchanges.
Features and Functions
Plan Management
many elements that are functions of the state insurance departments. After exchanges are implemented in
2014, states will need to continue to perform these roles to ensure QHPs meet the requirements necessary
for participation.
Carriers will be responsible for uploading and pushing plan information to HIX and maintaining this
information in WEM for data validation.
Other features include:
Ability to generate plan data in appropriate format and upload data to exchanges
Product and Rate Data
Provider Network
Quality Data
Integration with SERFF and HIOS
This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in whole or in part—for any
purpose other than to evaluate hCentive products or services. This document contains con dential and proprietary information specific to
hCentive, Inc.
5
7. hCentive
Technology Solutions to Simplify Healthcare
Enrollment Application
The Enrollment Application Management Solution enables the insurer’s existing enrollment processing
system to connect to multiple state HIX without implementing multiple management systems.
Key features include:
Business Rules based routing
Queue and Workload Management
SLA Management
Integration with back end services, such as letter generation, letter tracking, audit capture, etc.
Dashboards and Reporting
Customizable Business Process Management Framework
Reconciliation
Key features include:
Membership Reconciliation
Premium & Subsidy reconciliation
Capability to generate actionable work items and feed business process management systems
from reconciliation results
In Conclusion
hCentive’s WebInsure Exchange Manager is designed to adapt to current and future market changes. It
is expected that the landscape of public and private health insurance exchanges will continue to
evolve in 2014 and beyond. Data models and business processes will continue to change and require
insurers to continually realign their business models to adapt. WEM will help you cope with the rapid
changes brought by the reform; as well as enable you to stay ahead of the market.
existing business services and technical infrastructures. hCentive will leverage your existing IT
investments and resources to help reduce your costs.
Time is the biggest issue. Insurers need to move quickly in order to adapt to the massive changes in the
regulatory environment. hCentive’s WebInsure Exchange Manager enables quick adoption so you can
take advantage of these new opportunities.
This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in whole or in part—for any
purpose other than to evaluate hCentive products or services. This document contains con dential and proprietary information specific to
hCentive, Inc.
6
8. hCentiv e
Technology Solutions to Simplify Healthcare
For Further Reading & Questions:
www.hcentive.com
Get the hCentive Advantage
Corporate Headquarters
Contact Us
hCentive, Inc.
Phone:
800-984-7952
Sales:
sales@hcentive.com
Support:
media@hcentive.com
Partnerships:
partnerships@hcentive.com
12355 Sunrise Valley Drive, Suite 310
Reston, Virginia 20191
-----------------End of White Paper----------------This document is copyrighted property of hCentive, Inc. It should not be duplicated, used, or disclosed—in whole or in part—for any
purpose other than to evaluate hCentive products or services. This document contains con dential and proprietary information specific to
hCentive, Inc.
7
