Operational Optimization

Healthcare Providers face an unprecedented regulatory, reform, and competitive landscape that demands cost cutting throughout the business. TIBCO has long helped organizations increase the effective use of core systems, and our events-based infrastructure is the foundation Providers use for reducing costs, optimizing operations, and meeting reform.

Eliminate Unnecessary Costs

Providers reduce the costs of care delivery and administration by using TIBCO to effectively coordinate care, power a free flow of reliable real-time data, and enable time-saving patient self-service. By correlating data from all systems, including supply chains and provisioning, Providers optimize the use of valuable equipment, staff, as well as other limited resources, and are empowered to:

  • Meet changing priorities by adjusting scheduling and staffing in real time
  • Minimize fraud with visibility into claims patterns and intelligent automation

Intelligently Respond to Real-Time Events

Providers see through massive data with TIBCO's visual analytics to discover meaningful trends, opportunities, and risks. Then, capitalizing on these insights, Providers use TIBCO's robust process automation and event engine to automate processes based on event-driven business rules that intelligently respond to events in real time. With these capabilities, Providers:

  • Improve processes with exception management powered by real-time metrics
  • Capture metrics on quality and outcomes with dashboards and analytics

Optimize the Revenue Cycle

Reduce the number of outstanding claims due to electronic data interchange (EDI) errors and get paid faster. Ensure claim compliance with HIPAA requirements and payers’ specific business rules with Transaction Modernization. Efficiently process a large volume of HIPAA-based transactions – up to millions per day - in real time, batch, or hybrid with our blazing fast validation engine.

Intelligent Translation of ICD-9 to/from ICD-10

  • Identify frequently-used ICD-10 codes and pre-determine post-transition codes
  • Automatically create real-world test data to prepare systems and partners
  • Retain financial neutrality through the ICD-10 transition

Ensure HIPAA Transaction and 5010 Compliance

  • Speed the revenue cycle by eliminating ill-formed claims prior to submission
  • Reduce delays in treatment due to inaccurate eligibility requests

Comply with RAC Audits

  • Comprehensively track and report on operations per RAC audit requirements
  • Enforce evidence-based policies for audit trails of transaction information