IBM tailors wares for HIPAA readiness

Portfolio of software, hardware, training and services geared for healthcare and insurance companies.

By Ann Bednarz, Network World
November 04, 2002 12:05 AM ET

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BALTIMORE - IBM said last week it would offer healthcare industry customers software that can help them implement government-mandated business processes faster and with fewer IT resources than if they went at the process alone.

The new software, called WebSphere Business Integration for HIPAA, is tailored for healthcare and insurance companies that face looming deadlines to comply with the transaction, privacy and security regulations contained within the federal government's Health Insurance Portability and Accountability Act.

HIPAA is a set of federal transaction and data protection regulations for healthcare providers, plans and clearinghouses. The HIPAA regulations are designed to standardize electronic data interchange (EDI) among healthcare industry participants and to protect patient health information.

Specifically, the WebSphere technology translates HIPAA-formatted EDI messages into application formats that a company's existing systems use. IBM says it can help streamline business processes - by automatically populating new or updated member information across multiple health plans, for example.

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Tommy Gurganus, director of regulatory compliance at National Account Service Company (NASCO), says HIPAA compliance is a tougher challenge than a company might first envision.

"This is a major effort by all players, providers and vendors that deal with any healthcare insurance transaction, or privacy or security," Gurganus says. "It's a substantial change to everybody's systems."

Preparing for HIPAA
IBM’s HIPAA Readiness Solution Portfolio pools IBM hardware, software and services resources, such as:

Integration software: WebSphere Business Integration for HIPAA handles the integration and manage-ment of business processes specific to the healthcare and insurance industries.

Security software: IBM’s Tivoli line of security management software helps provision, manage and enforce security and privacy policies.

Database software: IBM Data Management for HIPAA can satisfy data tracking and retention mandates.

Training: IBM is working with content provider Health Care Compliance Strategies to provide e-learning courses about HIPAA readiness for healthcare provider and payer organizations.

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NASCO, which is based in Atlanta, handles health-benefits processing for 27 BlueCross BlueShield-affiliated plans. Last year it processed 75.7 million claims for more than 6 million members.

IBM's expertise with EDI transactions and code sets was a big draw for NASCO, Gurganus says. The company has been working with IBM for more than two years to ready its systems for HIPAA, reusing as many existing resources as possible.

"It could have been a lot more expensive for us to implement this had we gone in there and totally revamped our systems on our own," Gurganus says.

Today at NASCO, HIPAA-ready systems are in place. The company now is concentrating on testing real-world scenarios and making plan-specific modifications to meet the needs of its customers - the BlueCross BlueShield companies whose transactions it will be processing.