Payer
Dental Insurance
Technology
Azure Health Data Services
Azure API for FHIR
Azure Logic Apps
Key Outcomes
Achieved CMS mandate compliance
Enabled a framework and architecture for future interoperability requirements
VNB Health helped a dental care organization achieve compliance with the CMS Patient Access Rule by implementing a seamless and secure system for patient and provider data access.
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 dental care organization providing managed care dental plans for individuals and families. With a network of contracted dental providers, they serve communities across Oregon, ensuring access to quality oral healthcare.
Customer Situation
Meeting the CMS Patient Access Rule requirements was a key priority for the customer. They needed a system that allowed patients and healthcare providers to securely access essential health information. However, several challenges stood in the way. Their existing systems lacked the necessary capabilities to support new interoperability requirements. Additionally, ensuring seamless and secure data access for both patients and providers proved to be a complex task. Successfully achieving compliance required not only expertise but also a structured approach.
VNB Solution
VNB Health collaborated with the customer to assess their data infrastructure and identify compliance gaps. To facilitate secure and efficient data exchange, we implemented a structured approach tailored to regulatory requirements. Leveraging Microsoft Azure API for FHIR and Azure Logic Apps, we established a robust framework for interoperability. Furthermore, data-sharing practices were aligned with industry standards to ensure CMS Patient Access Rule compliance.
A seamless integration with the customer’s EHR system enabled real-time data synchronization. To enhance security and scalability, a patient repository was implemented in Azure SQL. Moreover, Azure Logic Apps-based data feeds optimized the synchronization of patient and provider information. As a result, the customer successfully met CMS requirements without disrupting ongoing operations.
Customer Benefits
- Improved Data Access: Patients and providers gained secure access to critical health data, leading to better care coordination and decision-making.
- Future-Ready Interoperability: The solution laid a strong foundation for future data-sharing initiatives, ensuring adaptability to evolving regulations.
- Enhanced Operational Efficiency: Automated and secure data exchanges minimized administrative burden while improving workflow efficiency.
- Streamlined IT Management: By simplifying the management of PHI in a secure cloud environment, the solution allowed the customer’s IT team to focus on innovation rather than compliance challenges.