Industry
Healthcare Insurance Payer
Technologies Used
Azure Health Data Services
Azure Logic Apps
Azure API for FHIR
Key Outcomes
Achieved CMS mandate compliance
Enabled secure management of PHI within the cloud
VNB Health utilized Azure Health Data Services to help a large payer integrate Provider Directory and Patient Access API secured with AUTH 2.0 security, ensuring compliance with the CMS Mandate.
Customer Profile
The customer is a prominent healthcare insurance provider serving a vast population. With a rich history in the industry, they are committed to delivering comprehensive healthcare solutions and enhancing member experiences. The organization operates in a highly regulated environment, necessitating robust and compliant systems. Due to the sheer volume of transactions and complex nature of healthcare data, the customer handles a significant workload, demanding efficient and reliable IT operations.
Customer Situation
The customer handled 270/271 Healthcare Eligibility Benefit Inquiry transactions to verify patient healthcare eligibility, coverage, and benefits. The customer relied on custom API interfaces built on Microsoft BizTalk Server to connect with multiple insurance payers. This complex integration environment, characterized by high transaction volumes and frequent changes, was prone to instability. Updates to one payer’s interface often disrupted connections with others. To mitigate this risk, accelerate development and ease the build, deployment and testing process, the customer sought an automated solution that would enable continuous integration and continuous delivery (CI/CD) with robust automated testing.
Customer Profile
The customer is a leading payer, serving more than 1.5 million members providing dental and vision insurance plans for individuals, employers, and government programs. These plans give the power of a national network of providers backed by local service teams located in Iowa.
Customer Situation
The customer needed to implement the Provider Directory and Patient Access API in order to comply with the CMS interoperability and patient access final rule, which was mandated in July 2021.
VNB Solution
Upon analyzing the internal EHR system of the customer and aligning the requirements with backend systems, VNB's integration team devised a solution to fulfill the CMS mandate using Microsoft Azure API for FHIR, Azure Logic Apps custom connectors and Azure Logic Apps.
VNB suggested integrating with the EHR via Azure Logic Apps and creating a secure patient repository in Azure SQL to facilitate access to the Patient Access API. Utilizing Azure logic apps-based data feed, the necessary data for the Provider Directory and Patient Access API was synchronized from the EHR to Azure API for FHIR.
To ensure security, VNB team developed Azure Logic App-based front APIs which were secured with AUTH 2.0 authentication. These APIs retrieved patient access and provider directory data from Azure API for FHIR, seamlessly assisting the customer in meeting the CMS mandate.
The VNB team upheld the technical, content, and vocabulary standards outlined in the ONC 21st Century Cures Act final rule, adopted by CMS for supporting the two API policies. Implementation guides for Claims and Encounter Data, as well as Provider Directory Data, were adhered to, and the solution was evaluated against these standards.
Customer Benefits
The customer derived advantages from the solution by achieving CMS mandate compliance. Furthermore, it established a framework and solution architecture to address upcoming interoperability needs, facilitated by Azure API for FHIR.
The solution built on Azure API for FHIR enabled the customer to implement a FHIR Service, utilizing the scalability of a compliant cloud environment supported by Microsoft Azure.
The solution built on Azure also aided the customer's IT team in navigating the challenges of securely and dependably managing PHI within the cloud environment.
