Virginia Premier Health Plan (Virginia Premier) has chosen to deploy the Infor Cloverleaf integration suite to solve a problem faced by many healthcare providers. The medical industry has used EDI (Electronic Data Interchange) for decades. The ASC X12 standard was first formulated in 1979 and the first version was published as an ANSI standard in 1982. Since then healthcare providers have used the standard to send messages between systems securely for a variety of tasks.
Virginia Premier outsources the translation of various document types to a bureau as do many other organisations. The issue with this is that it is often costly and those costs increase in line with usage. External systems also take staff time to validate both inbound and outbound messages.
Stopping the waste time on EDI in Virginia Premier
Virginia Health reached a point where this stopped their IT team fulfilling their primary tasks. They selected Infor Cloverleaf to resolve the issue. Carl Gattuso, Chief Corporate Officer for Virginia Premier explains why: “Infor Cloverleaf can handle our current and future needs because it’s scalable. We wanted the control and flexibility to translate X12 and other data files on our own and to stop outsourcing that service.”
Formed in 1995 Virginia Premier offers medical services to 185,000 people across Virginia. It is a full-service Medicaid health plan owned by the Virginia Commonwealth University Medical Center. Infor Cloverleaf will eliminate the requirement to use a bureau for document translation when implemented. It will also support the reconciliation and auditing activities for claims and enrolment processes. Its scalability means that the solution can evolve as Virginia Premier expands.
The Cloverleaf solution will enable them to transmit, receive, monitor and archive messages regardless of the format or transmission protocol. This may help them expand to link up with other organisations, which was not possible before due to messaging issues.
Mike Poling, senior vice president, Infor Healthcare commented: “Information from multiple data sources continues to grow in the healthcare industry, and it’s no surprise that organizations continue to face tough challenges when it comes to getting healthcare providers the information they need, when they need it. Infor is able to offer applications specific to the needs of the healthcare industry that ensure relevant information is available and easily accessible to the right people in order to help healthcare organizations avoid unnecessary and costly redundancies.”
Virginia Premier has found in Cloverleaf a solution to a problem that other healthcare organisations have grown to accept. The total cost is often a surprise when organisations calculate the true cost of EDI. They often ignore the cost of man hours required to check messages. The opportunity costs for those staff ignored. Bureau costs are also a significant factor, especially in a growth market. Companies need to carefully consider where they spend their limited budgets and need to rethink their strategy on EDI messaging.