Unique Partnership Creates Multi-functional EDI Solution - CSC Healthcare Group and EXTOL - Company Business and Marketing

Health Management Technology, Dec, 1999 by Jim Utsler

Customer needs and government dictates prompt two companies to partner in a value added reseller arrangement which results in maximum value.

The healthcare industry is becoming increasingly reliant upon electronic data interchange (EDI) to conduct its business. Healthcare providers need to electronically make transactions with their healthcare plan counterparts in order to smooth out process flows and keep staffing and materials costs low. This growing dependence on electronic commerce has many healthcare organizations turning to third-party information technology vendors for help.

But what does a vendor do when it needs help? In the case of CSC Healthcare Group, it turned to EXTOL Inc., which specializes in EDI solutions for a wide variety of industries and applications. Combining the best of their resources, the two companies developed a product that perfectly suits the needs of CSC Healthcare Group's customers and has exceeded CSC's annual sales expectations by 100 percent.

Group's Varied Customers

Computer Sciences Corporation has more than $500 million in annual healthcare revenues. Its Healthcare Group customers include many of the leading managed care organizations, hospital systems, academic medical centers, community hospitals, insurance companies, and multi-group practices in the country.

One of CSC Healthcare Group's key products is its POWER Managed Healthcare Information System. This integrated data processing and management information system is targeted at companies involved in managed care, such as large health insurance plans, point-of-service plans, HMOs, PPOs, and TPAs. It was designed to handle multiple benefit structures, complex provider reimbursement arrangements, utilization management, and claims processing. No small part of this product is the Electronic Commerce Module, which allows for the processing of EDI healthcare transactions.

"It's a full-featured managed care solution that performs claims processing, utilization management, eligibility benefits, accounts payable, and accounts receivable," says Tim Rogers, EC/EDI technology manager for CSC Healthcare Group. "Our EDI solution helps tie the entire product together."

Marketability Hindered

The product's EDI capability needed to be expanded to better serve the needs of CSC's customers. Early iterations of the EDI module were proprietary in nature, tied directly to third-party networked environments. This meant that if CSC Healthcare Group's customers wanted to conduct EDI, they had to either work through a third-party network provider or create their own EDI front end.

Unfortunately, because it was only suitable for customers who were already using--or were willing to use--these networks, the marketability of the product was hindered. CSC Healthcare Group needed a solution that would allow its customers to trade documents electronically without being tied down to a network format or transmission method.

Additionally, the EDI offerings were based on hard-coded interfaces that were unable to respond to the large variety of formats in use in the healthcare industry, including standard formats, UB-92 or NSF. This created an inflexible EDI environment.

Process ANSI X12 Standard

What CSC Healthcare Group sought to provide for its customers was a more automated flow, a richer data set, and the capability to handle the multiple formats they needed to support. They also wanted the ability to process transactions in ANSI X12 standard format in addition to the myriad proprietary formats that currently exist in the healthcare industry.

This desire to move to the X12 format was in large part driven by the advent of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which stipulates that all health plans, payers, and clearing-houses have to support the ANSI X12 format.

Hearing the calls of its customers--and the dictates of the government--CSC Healthcare Group decided to evaluate a number of EDI products to determine which would not only suit its customer's needs, but also provide a more marketable solution.

"What we were after was not only a product that provided the right capabilities," Rogers says, "but also a partner and value added reseller arrangement."

Selection Made

After culling through the product criteria, CSC Healthcare Group made a decision. It would add the EXTOL EDI Integrator to the Electronic Commerce Module of its POWERMHS Managed Healthcare Information System product. This EDI Integrator is a high-performance EDI translation system created specifically for IBM's AS/400 midrange computing system. With flexibility in mind, it was designed to route incoming EDI transactions to multiple platforms, applications, and maps without programming.

It supports all of the major standards, including UN/ EDIFACT, TDCC, UCS/WINS TRADACOMS, and, most important for CSC Healthcare Group, proprietary formats. It also supports ANSI X12 and HCFA-1500 standards created specifically for the healthcare industry.

X12 Support Important

"When we evaluated the standards area of each product, the deciding factor was its support of X12 and proprietary formats," Rogers says. "In other words, the standards needed to be defined in the software. That was the case with the EDI Integrator."