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The healthcare payer market faces constant change, driven by an evolving regulatory landscape, cost-reduction pressures from multiple directions, and ongoing security threats. Amid these challenges, payers must navigate legacy systems, grapple with system integration, and work to manage claims efficiently.
Many legacy claims systems struggle to meet modern data standards or integrate with other systems. Isolated systems lead to data silos, leaving no one with a single source of truth. At the same time, securing and maintaining legacy systems can add unwanted expenses and maintenance headaches.
In recent years outside of healthcare, there has been a revolution in data and data analytics. The onset of distributed cloud computing and its support for storage paradigms like data lakes has allowed for better flexibility around data management, even for the largest-scale data workloads. Many payers have been slower to move to these newer, flexible architectures; however, data management platforms make it possible to exchange data between legacy systems and cutting-edge technologies.
How Flume Transforms Claims Processing
In healthcare, nearly every company has its own unique set of systems and file formats. To connect systems, every new integration requires custom development, burdening payers with added cost and time delays. Flume provides a modern data management solution that connects and works with any existing system and standardizes the format for data transfer, securely transferring data through a permissioned model. Flume serves as the connective tissue between source and target systems, eliminating the need for custom development for integrations or data exchange.
Flume also captures data from the source system, transforms it programmatically, and delivers it to the target in the destination format. The first time you connect your data to Flume, it’s stored in the Flume Data Model, effectively a data lake, which resides in either the customer's on-premise environment or in their cloud application of choice. Systems can connect to Flume one time and trade data with their partners by assigning permissions.
Flume supports a range of standardized data formats (including EDI, FHIR, and NCPDP) as well as custom formats for most plan administration data types, including:
- Eligibility
- Medical Claim Service Lines
- Rx Claims
- Accumulators
- Authorizations
- ID Cards
- Groups
- Other/Customer-Defined
Flume allows you to seamlessly trade pharmacy claims between your PBMs and claims systems, or share eligibility data between your CRM and newly added point solutions. Supporting complex data transfers across multiple systems improves operational efficiency, while Flume’s dashboard allows you to quickly monitor the status of your transactions.
Source data is transformed into the Flume Data Model format and then into the target output. Complete files or a change feed can be sent to destination targets to provide additional flexibility. Additionally, Flume maintains file change history, ensuring data recall at any point. This traceability reduces the effort needed in an audit. These features work together to provide a flexible solution that meets your current needs while easily handling any changes in regulation or format in the future.
Flume also adapts quickly to changing data interchange formats. As new file formats are created or mandated by regulations, Flume proactively delivers compliant records without requiring development work from your IT team.
Boosting Efficiency and Lowering Costs with Flume
Legacy claims processing workflows are often plagued by inefficiencies, with manual processes, data silos, and constant format updates contributing to increased costs and extended timelines. Flume addresses these challenges head-on, delivering tangible improvements in efficiency, speed, and cost savings.
Organizations using Flume report a significant reduction in integration timelines and expenses, with faster deployments enabling teams to focus on higher-value initiatives. Flume’s configurable connectors and automated data transformations eliminate redundant manual processes, allowing claims systems to operate with greater accuracy and fewer delays.
By leveraging the Flume Data Model, organizations gain a single source of truth for their claims and administrative data. This eliminates inconsistencies, improves decision-making, and ensures better compliance with auditing requirements. Whether your integrations involve pharmacy claims, eligibility data, or authorization requests, Flume streamlines the process, reducing implementation timelines by up to 80% and increasing the number of integrations completed fivefold.
Security and Compliance
The constant threat of cyber attacks and widening threat surfaces means every organization must be concerned with security risks. Still, the worry in healthcare is especially acute. The personal nature of the data captured and regulations like HIPAA mean that providers and payers must take extra care to ensure the security of their systems and data.
Flume was designed from the ground up with enterprise-level security in mind. Data security measures include encryption for data at rest and in transit, with secrets and key management protecting sensitive data. Engineered with a sophisticated toolkit, Flume adopts a multi-layered security architecture to guard against threats and vulnerabilities.
To support compliance with regulations like HIPAA and SOC2, Flume’s security framework safeguards electronic protected health information (ePHI) from unauthorized access. Additionally, the Flume platform is HITRUST certified, demonstrating its adherence to the highest standards of information security, privacy, and risk management. This certification ensures your data remains protected within a framework trusted across the healthcare industry.
Flume protects your data, and its web portal provides superior control, enhanced visibility, and the ability to quickly make changes to data management. All your data is interchanged in one place, with a tracked history, further helping your compliance stance.
To ensure safety and compliance within our web application, Flume’s security model includes identity and authorization technology like multi-factor authentication and integration with providers like Microsoft, Google, and Okta to secure your login process. Beyond authentication, Flume uses a role-based access control model to easily define permissions for data access.
Key Takeaways
The healthcare payer market faces unique challenges in managing claims processing, navigating legacy systems, and meeting evolving regulatory standards. Traditional approaches rely on manual processes and custom development, leading to inefficiencies, high costs, and slower workflows.
Flume revolutionizes claims processing by:
- Providing a modern, flexible data management solution that integrates seamlessly with legacy systems.
- Automating data transformations to ensure accuracy and compliance with evolving standards like FHIR and EDI.
- Delivering significant time and cost savings, enabling organizations to complete integrations up to 80% faster.
- Enhancing security and compliance with enterprise-level safeguards and end-to-end encryption.
By simplifying complex integrations and ensuring adaptability to changing standards, Flume empowers payers to modernize their claims workflows, reduce operational burdens, and deliver better outcomes for stakeholders.
Want to learn more? Schedule a demo today to discover how Flume can transform your claims processing workflows.
