Insurance Provider Streamlines Member Claims and Transforms Partner Operations with Progress MOVEit
Challenge
Experiencing strong growth and facing changing regulatory requirements, this health insurance provider knew they needed a comprehensive solution to help manage their file transfers. Traditional file transfer methods lacked the security and encryption features they required for compliance regulations.
Solution
Progress® MOVEit® Transfer was chosen to centralize exchanges of patient health and claims data with external partners as well as support compliance with HIPAA via encryption and security features. Additionally, Progress® MOVEit® Automation was leveraged for automating previously manual tasks.
Result
- Partnered with 50+ external vendors enabling members to receive high-quality care
- Processed thousands of incoming claim files daily
- Reduced risk through enforcement of data governance policies
Full Story
Challenge
A non-profit health insurance provider has offered Medicaid and other affordable, high-quality coverage services to 700,000 community members for over 25 years. In the decades since its founding, the insurance payor has sought to protect sensitive data within file exchanges with providers, patients, regulatory agencies and partners. With strong growth and changing regulatory requirements, the provider re-evaluated their existing file transfer methods and decided to upgrade to a solution designed to simplify, streamline and secure file transfers.
The enterprise architecture and application development team led this effort. This team supports every business application in the technology infrastructure with custom development and integrations. “We've always had SFTP. We started out by using the standard Windows-based secure file transfer. As we grew, we needed an enterprise-class solution,” said the team's Senior Vice President.
At the business level, leadership was concerned with protecting personal health information (PHI) and complying with HIPAA regulations. According to the Senior Vice President, “Our company transitioned to MOVEit primarily because of the features and functions that it offered from a security standpoint, from an automation standpoint and from an administration and management standpoint.”
Our company transitioned to MOVEit primarily because of the features and functions that it offered from a security standpoint, from an automation standpoint and from an administration and management standpoint.
Senior Vice President
Healthcare Insurance Provider
Solution
Due to the nature of the healthcare insurance business, this payor uses MOVEit Transfer to facilitate critical patient information exchanges with healthcare providers and partners. “We have a lot of subcontracted vendors as a managed care organization,” the Senior Vice President said. “Take a pharmacy benefits manager for example. We're not managing pharmacy claims processing…we need to exchange data with those entities, and we do that through file exchanges as they have the members in their system and can service those claims.”
Without MOVEit Transfer, the organization would not have a centralized file transfer solution. This could result in an unmanageable number of one-off emails containing PHI data, increased spending on tools with limited functionality and higher levels of risk associated with maintaining regulatory compliance. MOVEit has helped the team take control of their file transfers with its security and encryption capabilities, granular logging and reporting and scalable offerings to support growing memberships and busy seasons.
“We also receive a lot of data from providers directly. If a provider sees one of our members, they want to bill us for the service that they performed, which comes to us via file exchange,” the Senior Vice President explained.
MOVEit Automation helped reduce the number of file transfers the team must handle manually. Many regular, recurring and cadenced transfers are now automated to save crucial person-hours for the team. “Automation is really what drove us to the solution. We're a small shop from a support perspective and receive thousands of files a day. Once a file has been generated, we can check the data it contains, make that transfer and verify that the transfer is completed,” the Senior Vice President said. “And vice versa. When we need to grab files, pull them down, process them and move them, MOVEit Automation helped us streamline that tenfold.”
MOVEit Transfer and MOVEit Automation have helped bring new efficiencies to internal processes, centralize visibility and shore up security in their claim workflows. HIPAA is a core driver of security concerns and the federal government agencies they work with. “I think it was more just the data volume we exchanged with third-party vendors,” the spokesperson said. “We're also doing this with the federal government so we can meet the standards set forth by our regulators from state and federal agencies.”
Result
MOVEit has simplified internal operations for this enterprise architecture team and the file transfer process for external vendors. The MOVEit web client provides a familiar folder-based user experience for collaborating with non-IT personnel. “Of so many different third-party vendors that we're working with, their technical capabilities differ vastly from one to the next,” the spokesperson said. “So, for folks who want to use it, the web-based client is a really nice feature.”
The managed care provider works with dozens of external parties. “We have probably 50 to 60 different vendor partners and are processing upwards of 3,000 files a day with file exchanges coming in and coming out,” the Senior Vice President said. Additionally, MOVEit has improved how cross-department teams work with each other inside the business. “By setting up a MOVEit automation routine that would look at a specific directory where the enrollment team drops a file, we can move that file to another directory for another team,” the spokesperson continued.
Lastly, and perhaps most importantly, MOVEit has enhanced the security of patient data before, during and after it is transferred. ”The security is robust, which obviously puts our security team and our CISO at ease,” the spokesperson said. MOVEit also helps the organization enforce data governance across the enterprise, further aiding compliance and reducing risk for the business. “We also use it for things like cleaning up directories, automatically archiving and data retention policy-type things,” the Senior Vice President concluded. “You can imagine, say, 60,000 files a month, and we need to make sure we're managing all of those properly.”
For over eight years, MOVEit has been this security-conscious insurance provider's managed file transfer solution of choice.
When we need to grab files, pull them down, process them and move them, MOVEit Automation helped us streamline that tenfold.
Senior Vice President
Healthcare Insurance Provider