Healthcare clinics and insurers need to ensure sensitive patient information are protected according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. While HIPAA paints in broad strokes about how patient information should be stored, transmitted, and shared among providers and insurers, the non-profit healthcare industry standards body CAQH (Council for Affordable Quality Healthcare) provides more detailed rules by which industry participants can play in order to be HIPAA compliant.
A few of those rules get more attention than the others, such as the methods and requirements outlined by the Connectivity Rules under CAQH CORE Phase II Rule #270 and CAQH CORE Phase IV Rule #470. These rules govern the secure sending and receiving of synchronous transactions, e.g., the real-time Patient Eligibility and Benefit inquiry and response (HIPAA 201/271). With the most recent release on October 19, 2017, TIBCO B2B (business-to-business) products now enable health care insurers and providers to exchange transactions in real-time using SOAP protocol. In addition to the single-transmission real-time method, asynchronous batch and error handling methods also outlined in the Rules are supported, too.
Healthcare organizations can save time, energy, and costs of overcoming the challenging technical hurdles of compliance by using off-the-shelf functionality embedded in TIBCO’s B2B products, i.e., TIBCO BusinessConnect 6.4, and its accompanying add-ons TIBCO BusinessConnect SOAP Protocol 6.2 and TIBCO BusinessConnect EDI Protocol 6.8. They free up IT and business personnel responsible for private processes (e.g., the processes touching the clinical and financial systems) from having to implement these methods and requirements, offloading them to the B2B domain.
This release signifies TIBCO’s commitment to the healthcare market, which has long been served by its BusinessConnect and Foresight lines of software products. TIBCO is powering 6 out of 8 regional Medicare Administrative Contractors in the nation, half of the Top 25 BlueCross / BlueShield insurers, and numerous insurance organizations at the state and municipal levels. Beyond healthcare, TIBCO’s mission is to help all customers gain competitive advantages through interconnecting everything with our complete integration platform and augmenting intelligence through our broad analytics platform. We help our customers integrate their people, data, and systems and to better manage and understand their business to make decisions and act in real time. For more information about TIBCO B2B in Healthcare, please contact us, or post a comment below.