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.

1. Reducing Risk, Cost and Complexity
Across Healthcare Processes
With the Lightwell Healthcare B2B Gateway

2. Introduction:
Persistent Pains for Healthcare Organizations
Today’s healthcare organizations must provide high-quality services while meeting rigorous industry
requirements. Their IT teams face tremendous pressure, as they must support more data formats, partners,
protocols, devices, systems, requirements, and end users than ever before.
Despite these challenges, they must ensure that critical data flows quickly and flawlessly between internal
systems and with their partners, because there is little room for error or delay in the exchange of healthcare
transactions. Delays and errors can lead to a wide range of problems, including a patient not receiving the care
they need when they need it most. This could be catastrophic.
However, because healthcare processes are so complex and often require human intervention, errors and
delays are far too common. Addressing these errors—combined with the need to ensure HIPAA compliance,
meet SLAs, prevent data breaches, and support a growing number of partners and customers/patients—has
created a tremendous amount of pain for many healthcare organizations. Here are just a few examples of the
impact.
Resource Time and Costs
There are many steps in the lifecycles of healthcare transactions—including enrollment,
eligibility, claims, claim inquiry, and payments—where data is exchanged between
organizations. Errors or delays in any of these steps can prevent the next step from
happening, resulting in delayed treatment, delayed payments, SLA
penalties…or worse.
Unfortunately, most organizations don’t have an easy way to know if and
when a failure or error occurred along the way, and can’t easily identify
the problem within a transaction set that contains a large amount of
data. Because of this, healthcare organizations must spend excessive
time and money to:
• Research, identify and fix errors
• Revise and resend transactions
• Reconcile claims and payments
• Communicate transaction status with their partners
Full-time staff may be dedicated to researching and fixing errors,
and often, organizations must pay overtime to overcome these
challenges. This is very costly, and ties up valuable resources.
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3. HIPAA Violations and Other Penalties
In addition, with multiple individuals manually reconciling data, personal and private
information is being accessed, this puts the organization at risk of non-compliance. If
personal health data is breached, there can be a significant per-incident HIPAA fine
for each record breached. In addition, organizations frequently lack records of who
accessed files, when they did, and what was done. This lack of audit trail could lead to
costly legal problems and HIPAA and PCI violations.
Lack of Visibility
At a management and executive level, healthcare organizations lack visibility
into these issues, and are challenged to identify and address the sources
of problems. They may become aware of a problem long after it has
worsened—perhaps even blind sided—while the problem could have been
avoided with early detection.
All of these challenges can lead to big problems in the healthcare industry,
and for many organizations they persist despite investments in multiple
systems, solutions—even custom developed scripts—to support these
processes.
Security Risk
Manual research and reconciliation processes are problematic, not only because of
the costs and risk of error, but also because they create a huge security risk. Data can
easily be stolen when it is downloaded and managed in a non-secure environment—an
individual’s desktop, stored on a USB, or sitting on a desk. In addition, there is risk of
fraudulent activity, as an individual could set up a fraudulent account and manipulate
claims. This has the potential of becoming a front-page nightmare for companies.
Financial Loss
Beyond staff-related costs, there is also potential for financial loss. When a provider
organization can’t easily reconcile what has been billed versus what has been received,
and what has been paid versus what has been deposited, they may be missing out on
payments they’re owed. On the other hand, if a payer makes a mistake and payments
aren’t made correctly or on time, they may be penalized and/or lose their discounts.
Reducing Risk, Cost and Complexity Across Healthcare Processes 3

4. Overcoming the Pains:
The Lightwell Healthcare B2B Gateway
Recognizing the impact of these challenges,
we developed the Lightwell Healthcare B2B
Gateway solution through our partnership with
IBM. At its foundation, the solution provides the
proven capabilities needed securely exchange
healthcare data with all partners, quickly
transform high volumes of data, and automate
complex healthcare processes.
In addition, it provides the powerful capabilities
needed to overcome the challenges described
herein, address HIPAA requirements (levels 1-7),
and reduce risk, cost and complexity across
healthcare B2B processes.
Leveraging the best-of-breed capabilities of
the IBM B2B Integration and Managed File
Transfer solutions, along with Lightwell’s proven
B2B Framework, the Lightwell Healthcare
B2B Gateway solution helps healthcare
organizations:
• Automate complex B2B processes, including
enrollments, eligibility, authorizations, claims,
and payments
• Securely exchange all transaction types and
formats with partners
• Reduce transaction errors and the costs of
addressing them
• Reduce the time and effort required to research
and reconcile transactions
• Gain end-to-end, real-time visibility and control
throughout the transaction lifecycle
• Provide authorized staff and partners a secure,
self-service web-based environment for viewing
and managing transactions
• Identify and address problems proactively
• Avoid penalties while ensuring HIPAA (all SNIP
levels 1-7) and SLA compliance
• Reduce the risk of security breaches
Furthermore, it helps to provide personalized
dashboards and reporting to key individuals, helping
them keep a pulse on activities as they happen,
while helping them view valuable trends around
transactions, performance, payments, and more.
All of this can help them address the source of
problems while gaining insights for better decision
making.
As a result, companies reduce costs, improve
processes, increase security, reduce risk, and
increase patient and partner satisfaction.
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5. Leveraging a combination of IBM B2B Integration and Managed File Transfer solutions, along with the Lightwell B2B
Framework, the Lightwell Healthcare B2B Gateway provides a wide variety of capabilities.
Healthcare B2B Gateway Capabilities at a Glance
• Encryption of data in motion and at rest
• Role-based permissions with identity
and access management, multi-factor
authentication
• Integration with enterprise security
infrastructure
• Perimeter security
• Real-time document tracking
• End-to-end document lifecycle visibility
• Visibility into where claims are in the
adjudication business process
DOCUMENT,
TRANSACTION AND
CLAIM VISIBILITY
• Centralized reporting on all data
exchange events
• Real-time notifications and alerts of
problems and failures
• Highly-personalized, configurable
dashboards with drill-down capabilities
ALERTS AND
REPORTING
• Automatic SLA/SLC monitoring and alerting
• Audit trails to easily support yearly audits
• Compliance with WEDI/SNIP (Levels 1-7)
standards
HIPAA AND SLA
COMPLIANCE
• Supports any-to-any transformation
• Supports AI maps and ITX maps (built in
HIPAA standards)
• Supports pre-validation, validation, and
data enrichment for improving
auto-adjudication rate
TRANSFORMATION
AND AUTOMATION
• Exchange all transaction types and formats
with partners
• Any-to-any integration, any-to-any protocol
• Real time or batch communications
• Rapid partner onboarding
B2B COMMUNICATION
AND COLLABORATION
SECURITY
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6. Advanced Capabilities Provided by the Lightwell B2B Framework
In addition to those provided by the IBM solutions, the Lightwell B2B Framework brings a powerful set of
capabiities to the Healthcare B2B Gateway.
Powerful Search
Capabilities
Users can easily search on transactions through a wide variety of criteria,
including Claim IDs, Patient Identity Codes, Subscriber and Group IDs—whatever
data is meaningful to the company. This decreases the time and cost to locate
specific transactions and claims.
End-to-End
Document Lifecycle
Tracking
Users can easily find and view related transactions in a lifecycle, enabling them to
quickly reconcile transactions while reducing the time and costs involved. This can
help ensure timely patient treatment and accurate provider payment.
Simplified Resending
and Reprocessing
Capabilities
Users can quickly reprocess and resend healthcare documents as needed. This
decreases time and cost, while reducing the amount of human intervention
required.
Secure Access via
Web Portal for
Authorized Business
Users and Partners
With B2B Framework, access to transaction information can be extended—safely
and securely—to authorized individuals inside and outside the company. The
data is kept within the B2B Framework (not downloaded to a desktop) while an
audit trail keeps a record of activity. This protects sensitive data while ensuring
HIPAA compliance. In addition, by empowering these users to view the status of
their transactions on their own, it reduces the number of internal and external
status inquiries to IT staff while improving satisfaction.
Proactive Alerts
B2B Framework keep managers and partners informed of performance issues
and transaction processing issues. It alerts the right individuals about issues
immediately and automatically so they can quickly address them.
Streamlined Partner
Onboarding and
Management
B2B Framework simplifies and streamlines the partner onboarding process,
reducing trading partner onboarding time from days or weeks to hours or
minutes. It comes with rules-based configuration and dozens of pre-built process
flows out-of-the-box, so no custom development is required to onboard a partner.
This reduces the cost of trading partner onboarding while improving time to
revenue from B2B relationships.
Individualized
Dashboards and
Advanced Reporting
B2B Framework provides individualized dashboards and reporting that enables
desginated personnel across the organization to gain insights around areas that
matter most to them, including: business performance (by geography, transaction
type, and more), operational performance, and partner performance. Reports are
highly configurable and individuals can drill down into the data for greater detail
as needed. Equipped with powerful insights, managers and executives can take
action on trends and make better-informed decisions.
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7. Reduced Cost
• Significant reduction in resource time and
costs associated with managing, reconciling
and remediating errors and issues throughout
healthcare processes
• Reduction of support calls and status inquiries
from internal staff, partners and customers
as a result of providing them visibility into
transactions
• Reduced management, maintenance and
support costs by consolidating onto an easy-
to-use, highly scalable enterprise B2B system
Reduced Risk
• Reduced risk of data security breaches, and
avoidance of related costs and fines associated
with them
• Faster detection and resolution of problems
and issues at multiple levels through real-time
dashboards and alerts
Avoidance of Penalties
• Compliance with legal and industry standards
and avoidance of HIPAA and SLA-related
penalties
Increased Productivity
• Increased productivity by reducing manual
processes and freeing up valuable resources
Improved Business Performance
• Improved performance through better
visibility into day to day operations and issues
• (For Providers) Acceleration of revenue
by improving payments processing and
addressing payment issues easier
• (For Payers) Avoidance of late payment penalties
and reduction of “where’s my payment”
inquiries
• Improved market intelligence and
decision-making based by extending real-time
insights to managers and executives
Increased Satisfaction
• Strengthened partner relationships by making it
easy to do business with you
• Improved customer service, patient care, and
patient satisfaction
Furthermore, because the Healthcare B2B Gateway
was developed with flexibility in mind, it will
enable you to quickly respond to new mandates
and regulations in this time of rapid political and
industry change. You’ll be able to support new
processes, rules, protocols and formats within this
system, while easily integrating with other systems
as needed to support changing requirements.
In addition, your organization will gain numerous
competitive advantages as it is able to spot trends
and opportunities quickly, deliver higher levels
of customer service, and develop new revenue-
generating offerings.
Benefits of the Lightwell Healthcare B2B Gateway
Learn more about the Healthcare
B2B Gateway and what it can do
for you. Contact Lightwell today at
info@lightwellinc.com or call us
at (614) 310-2700.
CONNECT WITH US
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