Modification of the CICS environment requires changes to the screen-scraping objects, which increases maintenance requirements. Modifications to the HIS 2000 components are less time consuming and easier to implement. To streamline the solution even more, as well as to reduce costs, RealMed is investigating the implementation of HIS 2000 to provide a real-time connection back to the insurance companies' legacy systems. This connection enables healthcare providers to check eligibility for referrals and treatments, submit claims, and check the status of claims through a Web interface in real time. The RealMed solution adjudicates the claim and immediately delivers an explanation of benefits to the healthcare provider's office.
Patients thus know what was covered and what they owe, before they leave the provider's office.
We believe that this system can reduce the processing cost per claim by more than 50 percent for payers and providers. The heart of the solution resides in the RealMed Data Center in Indianapolis, Indiana. The goal is to have the providers' offices connect over the Internet to the Web servers in the RealMed Data Center. To determine eligibility or adjudicate a claim, RealMed then connects to the insurance companies. The results come back to RealMed through HIS, and are then passed to the Web server and back to the provider over the Internet.