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The amount of data in the world continues to explode, and the problem these days is less about accumulating it than it is about understanding it. The sheer volume of data organizations must grapple with quickly creates complexity, and trying to deal with it manually can rapidly get out of hand.
This challenge is especially pronounced in the healthcare space, where stringent regulations can limit data processing options. Billing, with its web of billing codes and definitions, is a particularly difficult area in this regard—compliance with requirements related to privacy, security and technology can present an obstacle to employee efficiency and customer service.
Practice Alternatives, a longtime Progress OpenEdge partner and provider of a certified EHR (Electronic Health Record) system, management software and expert billing services for the medical community, identified billing as an area with major potential for improvement. If they could cut through the complexity, they knew they could make life easier for their existing customers—and maybe even start a whole new stream of revenue.
Practice Alternatives already provided a billing solution, but it was limited to providing a yes or no answer as to whether the procedure would be covered by a patient’s insurance. While the user could access more information, this was often in the form of difficult-to-decipher messages, which created confusion. It wasn’t always easy to tell how much of the procedure was covered, what final costs would be or what the reasoning was.
To get better details, Practice Alternatives queried a third-party company that provided information on copays, deductibles, network information and more. However, the queries were returned in an “X12 271” coded message, which is a healthcare eligibility/benefit protocol. The typical 271 message is essentially a long string of text with over 97 different code types, which must be translated to be legible for users.
As you can imagine, this wasn’t easy to work with. Practice Alternative’s original solution was to hand-code a function to translate these messages. This code had to be kept up with 90+ tables maintained by outside entities, and required a very specific skillset to maintain. Keeping this up to date was a challenge, to say the least.
While looking for a better way to solve this data access problem, they discovered just how much Progress DataDirect could improve the process.
Progress DataDirect is our leading data connectivity solution for enterprises that need to better integrate data across relational, big data and cloud databases. Practice Alternatives is a longtime Progress Application Partner, and their billing solution, Rexpert, is built on Progress OpenEdge. It was when describing the problem to their Progress account manager that the manager pointed out that DataDirect can handle X12 messages with its converters for EDI.
DataDirect converted the long X12 string to JSON, and provided text descriptions of all the codes in the X12 string. Just like that, Practice Alternatives could easily manipulate the data and put it into the HTML provided to the user, so patients could understand their options in plain English.
“With DataDirect, everything we needed was right there,” explained Anne Disney, Lead Software Engineer, Great Valley Technologies (a daughter company of Practice Alternatives). “It took an enormous weight off our shoulders.”
The integration process took just one week, and Practice Alternatives was soon rolling out their new solution.
The early results are positive for patients, who now have much more information at their disposal. For example, rather than a yes or no response to a question like, “am I covered for this test,” practices can now say: “you’re not covered for a scan now, but you will be in two weeks—would you like to reschedule, or pay out of pocket to do it sooner?”
Not only is this an improvement for Practice Alternative’s existing Rexpert users, but it has opened up an entirely new source of revenue for them. They have now made a web service available for outside customers to enable them to translate their own X12 271 messages into an intuitive results page as well.
As a longstanding partner like Practice Alternatives can attest, at Progress we’re dedicated to the success of our customers and partners. If you’re a Progress Application Partner, or even if you’re not, get in touch with us today to solve your data access or other business challenges.
To learn more, read the full story of Practice Alternatives below, or check out what DataDirect and OpenEdge can do for you.
Read Practice Alternatives' Full Story
Barbara Ware is Sr. Product Marketing Manager, responsible for positioning and messaging OpenEdge and OpenEdge Professional Services. She has 19+ years of experience in technology marketing leadership, strategy, content, communications and lead generation activities. You can find her on LinkedIn or on Twitter at @barbara_ware.
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