IT Management

Getting the right information to the right people faster to facilitate customer satisfaction and efficient operations is a challenge in healthcare, as in all industries. Coping with a labyrinth of paperwork and ineffective billing systems, medical patients—already worried about their medical problems—want to quickly determine their portion of their medical bills.

Patients have at least one organization that, while probably unfamiliar to them, is an ally. Antares Management Solutions, located near Cleveland in Strongsville, OH, is leveraging the power of the Internet to accelerate information sharing for healthcare providers—giving them a chance to save money and pass the savings on to patients.

Antares—a 500-employee unit of Medical Mutual Service, LLC, a for-profit subsidiary of Cleveland-based health insurer Medical Mutual of Ohio—provides best-in-class business process and applications hosting services for the insurance industry and IT services for small- to medium-size organizations in North America. Healthcare is among its primary industries.

Web-Enabling Medical Claims

“We wanted to leverage our medical claims system by using the Internet so we could offer claims information to healthcare providers for immediate results, enabling them to then share this cost information with patients,” says Jason Haines, Antares System Development Coordinator.

A patient today might go into a doctor’s office to get a vaccination and a checkup, be asked to make an initial co-payment, then wait a week or two to receive information about the visit and his or her payment responsibilities. During this time, the patient isn’t sure how much of the visit the insurance company will cover, which generates additional anxiety.

“By Web-enabling our System z-based medical claims system for providers, we can now put the providers in the position where they can immediately print out coverage and cost information for patients when the services are provided,” says Haines. “There’s no more waiting and guesswork.”

Currently, about 50 medical providers are using this system with Medical Mutual, Haines says. He adds it will take awhile for all medical providers to adopt Web-enabled claims information because it requires changes to office business processes that must be aligned with the new capability. Justifying the investment are several potential benefits:

  • Lower costs
  • Faster processing time
  • Improved provider service to patients and corresponding increase in patient satisfaction.

Antares’ host system for medical claims is a System z10 Model 2097-408 with 1,460 MIPS. The system runs with WebSphere MQ version 6, DB2 9, CICS version 3.1, and z/OS version 1.9.

Bob Porinchok, Antares’ Capacity Planning and Performance specialist, says most of his company’s strategic systems run on the System z. “They include our claims operations system, our client and member customer management system, our managed care system, and our provider system for hospitals, doctors, and other healthcare service groups,” he says. “Most of these systems run in a DB2 database environment. The claims system, which was designed in 1978 and installed in 1988, is still running both effectively and efficiently. Most of its data originally resided in VSAM files, which we’ve been converting over time to DB2.”

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