Benefits

Independence from third-party vendors
Because they organized integration processes in-house, the staff at this vision benefits provider no longer had to depend on outside vendors to correct problems with claims.

Faster claim turnaround time
With more control over file conversion, they were able to decrease their turnaround time on claims, allowing providers to get paid faster.

More automatic and accurate processing
“We are now able to do things we couldn’t do to begin with,” said the Director of Information Technology. “The automation reduces time we have on the processing end, so we are better able to work with internal staff and external clients, to strengthen our business.”

The Manager of Eligibility Data commented, “With Pervasive Data Profiler, we have less manual and more accurate processing – reducing errors since we no longer have to manually go through and track errors and validate the data.”

Reduced overhead costs
“Before Pervasive, we were paying 30 cents per claim for an outside vendor to translate the files from our Oracle database to HIPPA 837 format. Considering the number of new clients we have and the number of new counter claims we are required to generate, Pervasive has really saved us a lot of money,” the manager added.

Printable Format

Big Advantages With An Automated Integration Process 

A benefits manager that arranges vision benefit programs for more than four million individuals nationwide looked to Pervasive Software to automate the processing and retrieving of various types of data files.

With Pervasive Data Integrator, this company downloads flat files with proprietary layouts from between 200 and 300 external and local trading partners, which are then run through Pervasive integration software into an Oracle database repository for downstream claims processing and to generate reports.

“The benefits of automating this process with Pervasive have been huge,” said the Director of Information Technology. “Our sources of data have multiplied exponentially since we started this project. But the increased business has not required us to increase our staff.”

Manual Error Tracking Causes Overhead Costs to Rise

The staff at this company needed to transition the healthcare claims processing integration tasks from third-party vendors to an automated in-house process in order to speed up processing time—especially pertaining to the time spent waiting for outside vendors to correct processing errors when they occurred.

Additionally, they wanted to decrease the per claim overhead costs that were incurred through the outside vendor, as well as eliminate the slow, manual error tracking that needed to be performed.

Healthcare Standards From 4010 to 5010 Schemas

When searching for a solution, the IT team briefly looked at Informatica as well as Pervasive, but chose Pervasive because of its significantly lower price and better process automation functionality.

The IT team started working with Pervasive integration software three years ago to transform proprietary flat file formats, and HIPAA 834 and 837 claims and eligibility file formats using the 4010A1 standard. With Pervasive, they are prepared to handle even extremely uncommon data file formats which they receive on occasion.

The automated process integrates incoming data from all 200-300 trading partners smoothly with the Oracle database. It generates and sends standard HIPAA 997 and 277 response files, as well as monthly HIPAA 837 or proprietary format claims encounter reports back to clients.

Pervasive has recently provided this company with the latest 5010 schemas, and they have been integrated into the mappings. The IT team and Pervasive are now working on partnering a solution to create Companion Guides and validate the mappings with all of their EDI trading partners.

Thousands of Dollars Saved by Automating Claims Processing

By automating their healthcare claims processing and moving it inhouse, this company was able to eliminate payments to an outside vendor to translate files.

“We’ve saved tens of thousands of dollars per month since we started using Pervasive. On top of that, we haven’t had to grow our staffing in the data center because we can do more with less. When you factor in not having 2 to 4 additional FTE’s by now, that would easily be a savings of $250,000 to $300,000 per year,” the Director of Information Technology said.

He added, “More timely processing is beneficial on both ends, both for us and our clients. And the processing is more accurate as well.”