Much inefficiency can occur when an electronic transaction is first entered into your healthcare IT system, or even earlier in the business process as a result of interoperability issues across the industry. Compounding the problem are new market offerings such as Consumer-Directed Health Care (CDHC), ePrescribing, Medicare and similar care management plans that introduce new trading partners, and new document standards and interoperability models. Managing this complexity puts more pressure on your electronic "front door" and your core business processes.
 Such inefficiencies result in unnecessary expense due to manual intervention and processing delays to errors and rework. Such inefficiencies can incur financial penalties and damagecustomer relationships when service level agreements (SLAs) are not met. As the organization grows, these performance issues grow at a disproportionate rate.
Legacy adjudication systems simply can’t keep pace with the market and regulatory dynamics of today’s healthcare industry.
Agile solutions that automate core business processes from the point of service through claims payment, sales through enrollment, case installation and billing are a must. Moreover, process orchestration that, through the power of Service Oriented Architecture (SOA), leverages existing investments in existing business applications is required for cost-effectiveness and flexibility.
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Transform Core Business Processes while Enabling Health Information Exchange (HIE) and Electronic Health Record (EHR) Interoperability
Vitria® solutions enable you to transform your core business processes with a new breed of “out-of-the-box “Business Process Application (BPA). These BPAs automate and simplify the management of critical, complex healthcare transaction processes that span multiple systems, multiple formats and multiple trading partners. |
Vitria’s Healthcare BPA Suite begins with the consolidation of electronic transactions, of all types – HL7, HIPAA, NCPDP and custom into a single, secure information exchange gateway. With Vitria’s powerful Business Process Management and SOA tools, key transaction-oriented business processes such as claims, enrollment, attachments, and pricing are readily transformed leveraging existing core applications. With the added power of Business Exception Management, exceptions that occur in business processes can be automatically detected and resolved, or routed for manual resolution based on user-defined rules.
With Vitria’s healthcare BPA’s you are assured of intelligent interoperability with your trading partners whether they are providers, intermediaries, third-party administrators (TPAs), Pharmacy Benefit Management (PBMs), financial services, Centers for Medicare and Medicaid Services (CMS), care management partners, purchasers or of course your members. With all your e-transactions consolidated as they enter your system, you can transform your transaction-centric business processes, from front-to-back, for even greater efficiencies. End-to-end process visibility and intelligent exception management ensure thatSLAs are met, and that processes can be continuously improved.
 While delivering measurable business performance benefits, Vitria’s suite of healthcare BPAs reduces your total cost of ownership by keeping pace with continued administrative simplification regulations and enabling consolidation of care management programs on the road to Electronic Healthcare Record (EHR) interoperability and Regional Health Information Organizations (RHIOs).
Business Benefits
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Reduces ongoing transaction administrative costs by up to 50% |
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Lowers claims intake costs by up to 10 cents per claim |
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Increases Auto-Adjudication rates by 10% |
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Lowers premium billing costs by up to 60% |
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Decreases time to cash by 66% |
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Reduces premium bill generation costs by 33% |
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Increases administrator productivity by 25 - 40% |
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Lowers total cost per claim by 17% |
In keeping with its history of innovation, Vitria is the first company to offer packaged enterprise applications that represent a process-based approach. And, Vitria is the only company that offers a complete business process solution for the healthcare market.
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Vitrias healthcare and insurance BPAs include:
Smart Gateway for Healthcare™
An electronic information gateway and exchange that manages the intake, transformation, processing and forwarding of all electronic transactions with all external constituents. Smart Gateway for Healthcare also lays the foundation for clinical interoperability.
Resolution Accelerator
Automates transaction exception repair and enhances the process whenever manual intervention is required. Resolution Accelerator increases retention and new business while lowering cost and risk and, it prepares you for coming legislation.
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A Foundation for the Future
Vitria solutions are based on Service Oriented Architecture (SOA) principles and standards, a new approach to software design that helps organizations weave together diverse information technologies in a way that assures each technology’s independent functionality while simultaneously enabling them to collaborate effectively within large scale business processes without having to scrap the investment or custom develop massive amounts of code.
Download our brochure to learn more about preparing for EHRs RHIOs, HIE and more
Visit the SOA Resource Center to learn more about Vitria’s SOA approach.
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“Vitria lowers transaction automation costs by up to 50%"
