This IBM® Redbooks® Solution Guide provides an overview of how enterprises can accelerate the development of B2B integration solutions that facilitate compliance with the US Affordable Care Act (ACA). It also shows how data processing can efficiently process data governed by the evolving body of Health Insurance Portability and Accountability Act (HIPAA) data standard and related mandates.

Products: IBM Standards Processing Engine, IBM Transformation Extender, IBM Integration Bus

The healthcare payer ecosystem in the United States has changed dramatically over the last decade and is expected to evolve at an even faster pace over the next few years. Many world-class companies involved in healthcare payment processing are finding themselves constrained by their existing information technology infrastructure. The silos that they built around business-to-business (B2B) processing are constraining them, making it difficult to achieve governmental mandates and (more importantly) increase processing efficiency and competitive advantage.

Gone are the days of a small set of data following static and simple standards traded between a limited set of organizations. Gone are the days where the rules for when data is valid versus invalid can expressed in a paragraph or two. Gone are the days when information about a healthcare payment was almost entirely about the "who," "when," and "how much."

The payers’ world today requires adherence to multiple industry standards, government regulations, and industry expectations. It is becoming more technical and payers need to become more agile (Figure 1). IBM Transformation Extender Advanced is your answer to B2B enablement in today’s complex HIPAA/ACA (Health Insurance Portability and Accountability Act/Affordable Care Act) world.


Figure 1. Today’s healthcare payer infrastructure: More than just claims

Did you know?

IBM Transformation Extender Advanced provides a modular, comprehensive solution for transforming for healthcare payers. It includes these features: