As a result of HIPAA and increasingly high administrative costs, many healthcare organizations are streamlining their core functions. IGI is simplifying the healthcare administration by offering ETS, a moduler system, to payers that will allow providers and trading partners to:

• Check patient eligibility and benefit plan information
• Submit claims for auto-adjudication
• Enroll members on-line and select primary care providers.
• Process Referrals
• Receive Claim Status inquiry

IGI’s e-Health solutions are aimed at connecting various administrative functions of healthcare organizations. Our Enterprise Transaction Server is a complete solution that comprises individual modules that are HIPAA compliant, completely secure, and allowing multiple business partners to communication seamlessly with each other over secured networks.

The individual modules of the ETS are:

Claims Management Server

Multiple trading partners can send/receive their claims in any given format (including print image). This system will validate the file and user, scrub the data, process payer or plan specific edits, translate the data and load it into a staging Data Mart. From the Data Mart, information is edited for required fields; dates are validated and relational fields and values are processed. The industry standard fields are compared for value against master tables. Claims that do not meet the required criteria are marked for Rejections. All accepted claims are loaded into the Payer Adjudication system for processing. The Claims Management module also processes: claim status, electronic remittance advice, electronic funds transfer and explanation of benefits as this information is downloaded from the Payer Adjudication and loaded into the Data Mart. Through a web based front end or email, trading partners, providers and members can query, download or receive these transactions.

Eligibility Enterprise Server

This module facilitates the processing of online member eligibility request via a web based front end. Providers can submit an online or batch Eligibility Inquiry, which is routed to the appropriate payer’s Eligibility database. This application allows providers to get a response in real time, without the hassle of waiting on the phone line. The information that is obtained through the eligibility request is HIPAA compliant and gives details on: Member and dependent verification, Provider information and Member health plan benefits. The backend module is in synch with the member files on the payer legacy enrollment system.

Enrollment & Benefits Manager

Our Member Enrollment module allows employees, health plan members, etc. to enroll via an customized electronic web based form. It further has plug-in modules to primary HR systems like SAP and PeopleSoft. Furthermore, it allows employers to send proprietary Member Eligibility and Benefits to the Payer. This data is loaded into the Data Mart and retains the benefits plan by the group id and can be customized at the member level. Any authorized personnel, based on their privileges can update, query, upload and download data from this Data Mart.

Case Management System

This module allows PCP, providers, specialists and payers to exchange referral forms and Pre-certifications and authorizations electronically. The case management data server is designed to be an intermediary referring physician and the specialist and hospitals. The system manages the utilization by of the services permitted and the member eligibility. It is the key driver to help better manage the health of the patient and minimize the risk to their well being.

Security Module

This module acts as a funnel for all traffic into the payer system or databases and properly secures all user traffic as per the HIPAA guidelines. By using this module, Health plans can direct all trading partner traffic through the same portal and then authorize and authenticate user privileges from their profile.

For more information about the Enterprise Transactions Server call an IGI rep today!


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