Stay HIPAA and EHR compliant while sharing data internally and between partners
Payers must be able to share electronic information with a variety of ecosystems in a cost-efficient manner, while maintaining strict security to ensure compliance with stringent financial and healthcare regulatory requirements. To support the exchange of enrollment and payment information with Accountable Care Organizations (ACOs), payers must adopt a comprehensive integration technology to help ensure expansive compliance requirements that apply to data privacy, residency, and transfer. Further, EHR initiatives for “meaningful use” with healthcare providers requires secure and interoperable transmissions, for essential and continuous compliance related to all data exchanges executed across the healthcare payer’s digital matrix.
How Cleo healthcare solutions benefit payers
|Problem||Key Capabilities Needed|
|Compliance||Support governmental, financial, and healthcare regulations including NAIC, HIPAA, HITECH, PHI, HL7, MLLP, IAS/IFRS, Basel II, Sarbanes Oxley Act (SOX), Solvency II, BSA/AML, SAP, MiFID, SEPA, ISO/IEC 27000 series, and the EU Data Protection Directive.|
|Interoperability||Facilitate increasingly complex and varied connectivity requirements with a massive array of supported protocols native to the integration platform.|
|Speed to Revenue||Access an extensive connection library to provide rapid connectivity with new partners in minutes, speeding the time to revenue.|
|Auditability and Tracking||Ensure and prove compliance across your entire payment ecosystem with proven and transparent audit trails for granular transactional tracking and file-specific logging.|
|Automation||Deliver optimal quality service and maximum value to your customers through automation, eliminating time-intensive manual steps during enrollment, authorization support, and claims support processes.|
|Accelerated File Transfer||Data Speed: The speed of realizing optimal business outcomes is directly tied to how fast critical financial, health, customer, and proprietary files move, and how quickly essential data reaches key systems and stakeholders. File acceleration is a mandatory component of your integration platform because previously reliable methods of sending and sharing information such as FTP, email, or physically mailing, are either incapable or simply too unsecure to be trusted.
File Size: Payment data signifies more than a steady stream of files. In fact, unprecedented file sizes are challenging even the most robust legacy systems, undercutting transfer reliability and slowing down healthcare and insurance exchanges. Cleo’s extreme file transfer solution provides extraordinary carrying capacity to handle even the biggest files without slowing down your business.
Meet Partner SLAs: The need for compliance impacts the business at every level, but not all forms of compliance come from regulatory bodies and governmental agencies. Cleo provides the file acceleration technology to ensure delivery contingent and time sensitive SLAs.
|Application Integration||Automation: Even minute increases in the speed of systematic digital processes can have amazing results in delivering more value to your business. Cleo’s automation capabilities mean your method of facilitating transactions and securely integrating medical and financial data are accelerated helping ensure prompt outcomes for all business units.
Integration: Flexible digital process integration into backend systems is integral to increasing efficiency across the organization. By bringing this value to your business, Cleo helps you optimize the speed and quality of care across your enterprise ecosystem with dynamic integration.
SLA/KPI Management: Effective and efficient management of SLAs and KPIs are tied to transfer security and reliability metrics. With Cleo, quickly and easily gain insight into changes over all transactions to proactively alert key integration stakeholders.
|Big Data Gateway||Scalability: Dealing with modern data growth means that volumes can quickly outgrow the carrying capacity of your business gateway. Cleo’s Big Data Gateway solution with carrier-grade scalability, allowing you to is reliably ramp up even the most volume intensive big data initiatives with agility.
Interoperability: For the solution to reliably integrate essential business, provider, and patient information into your big data platform, interoperability must be assured. Cleo’s Big Data Gateway is a truly modern solution, but one that can seamlessly interoperate with existing infrastructure and legacy applications to ingest all your data and facilitate the creation of a real data lake.
Data in Motion: To fulfill the promise of your big data initiative, massive volumes of data need to be able to move across complex infrastructures bridging on premise systems, the cloud, and distributed storage architectures. The Cleo Big Data Gateway ensures that you can gather and securely move all of your file, message, and event data to power your big data storage and analytics platform.
|Any-to-Any Data Transformation||Integration: The value of true any-to-any transformation extends beyond data mapping to include ground-to-cloud integration. Cleo’s Any-to-Any transformation solution facilitates integration between on-premise systems and cloud-based applications key to driving the next technological iteration essential to tactical business outcomes.
Speed to Revenue: Design custom transformations that facilitate repeatable business processes across enterprise boundaries, speeding your time to revenue and optimizing trading partner onboarding.
Lower Costs: Reduce operational delays that cost your business time and money. Eliminate consultancy costs tied to replicating and managing manual processes and hand coding.
Want to learn more?
See Insurer Case Study
See Healthcare Payers Document