HIPAA Info for IT managers of Health Care Payers

Absolutely.  This can be a reality for your organization because DWL has proven it at many Fortune 500 companies.  If you take a moment to read the recent report issued by the CDI Institute regarding healthcare payers, you’ll see that during 2005-06, market-leading healthcare payers must add customer data integration (CDI) capabilities to their list of ‘strategic IT investments’ to increase customer satisfaction and retention, increase profitability and create operational efficiencies. Read the report - Click here


One of the challenges most healthcare payers face continues to be recognizing members and providers at any touch point because member data resides in multiple data silos.  Multiple instances of customer data in multiple business systems will not support optimized processes because the data is not consolidated. Customer service and wellness campaigns, along with critical business processes such as eligibility management, provider data management, claims management, and identity management are compromised if accurate member and provider data is not injected into operational processes.  If this remains a key inhibitor to your business, you need to understand how best to approach the challenge.  You are not alone; according to the CDI Institute, more than 65 percent of global 2000 organizations are actively evaluating one or more CDI solutions.


Another challenge for all healthcare payers is compliance with HIPAA legislation, and specifically the HIPAA National Provider Index.  Many healthcare payers continue to struggle attempting to integrate healthcare providers' unique NPI identifier with their own internally assigned identifiers, provider locations and network contract information.  This can inhibit healthcare payers from streamlining administrative processes such as billing and claims processing and provider customer service, as well as hindering initiatives such as provider web self-service and pay-for-performance programs. 


Healthcare payers need to go beyond acquiring and cleansing member and provider data by enriching, maintaining and using member and provider data to improve processes and promote overall profitability.  A complete operational customer master data hub goes beyond data cleansing and makes your member and provider data actionable and intelligent.  DWL calls this ‘Core CDI ’.


We invite you to learn how to build a solid foundation of member and provider data and deliver actionable data to all channels.  For a free copy of The CDI Institute’s, “Master Customer Data Systems:  The Business Case for Customer Data Integration At Market-Leading Healthcare Payers,” please visit www.dwl.com/healthcare.  To learn how DWL can help your organization achieve compliance with HIPAA NPI requirements, please visit www.dwl.com/npi.


Karen Jay
Group Director, Marketing & Corporate Communications
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