Medical Insurance in Lebanon Is Verified in Seconds with Integration Solution

“We needed some way of exchanging data between different environments. Here was a situation where IT could really make a difference to the quality of life for thousands of people.”

Mario Chartouni, IT Manager, Bankers Assurance

Lebanese company Bankers Assistance was frustrated about the time it took to verify medical insurance policies. Patients sometimes waited up to 20 minutes before all checks were made and treatment given the go-ahead. By deploying Microsoft® BizTalk® Server 2006, Bankers Assistance has reduced this verification process to seconds. Today, customers are receiving treatment more rapidly and hospital personnel feel more in control of their workloads.

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Document published June 2008

Business Needs

Bankers Assistance is a third-party medical claims administrator for Bankers Assurance, a leading health insurance company based in Beirut. Since launching in 1972, the company has grown steadily. It employs 200 personnel and serves more than 150,000 policyholders across the country. Lebanon relies heavily on health insurance schemes to meet the needs of its population. Each year, more than 75 per cent of the health ministry’s budget can go on reimbursing medical policies. So the importance of organisations such as Bankers Assurance in maintaining the health of the nation cannot be underestimated.

People entering hospital want treatment fast. In Lebanon, patients with health insurance must have their policies verified by the hospital before seeing a nurse or doctor. But Bankers Assurance policyholders sometimes waited up to 20 minutes before treatment was given the green light, while hospital personnel contacted the company, checked a patient’s cover, and updated their own systems. The company wanted to streamline the whole process so insurance policies could be checked in seconds and medical treatment provided more rapidly.

Mario Chartouni, IT Manager at Bankers Assurance, says: “The answer lies in linking our IT systems more closely with the hospitals. That way, policies could be verified within a few clicks of a mouse and patients sent for treatment immediately.”

The problem was that the Bankers Assurance Oracle-based systems differed from the systems of many Lebanese hospitals. “We needed some way of exchanging data between different environments,” Chartouni says. “Here was a situation where IT could really make a difference to the quality of life for thousands of people.”

Solution

Bankers Assurance turned to its IT solutions provider, Netiks, which had worked with the insurance company on a number of IT projects in the past. The solution at the top of the list was Microsoft BizTalk Server 2006. It fits the business needs perfectly and Bankers Assurance had good experience of working with Microsoft. Chartouni says: “Support from Microsoft in this region has always been excellent and the software is very easy to manage.”

Work on deploying BizTalk Server 2006 began in the middle of 2007. Within a few months, Microsoft Gold Certified Partner Netiks had completed the implementation, including testing, and the technology went live in November of the same year. Chartouni says: “Thanks to the professional intervention of Netiks, we avoided any significant technical challenges. Our biggest challenge, in fact, was non-technical and involved getting the hospitals to support our plans.”

BizTalk Server sits between the Bankers Assurance core insurance database and the hospitals’ records systems. Through secure Web services, the request for policy verification travels from the hospital to BizTalk Server, which sits on the edge of the Bankers Assurance infrastructure.

Before, patients had to travel to the insurance company and wait for approval. Authorisation involved several steps, including the submittal of printed documents to the hospital before billing could take place several days later. Today, the patients present their ID cards directly to the hospital finance office. The requested services are submitted directly from the billing system to the insurance system. Here, they are validated and approved, or rejected. The patient’s bill is issued and the insurance company notified immediately.

Benefits

Bankers Assurance has raised the bar on medical insurance services in Lebanon. It’s the first insurance company in the country to offer this streamlined and incredibly efficient way of verifying policies. The company has yet to quantify the benefits, but anecdotal evidence says customers are more satisfied, hospitals have cut down administration time, and Bankers Assurance is saving money. Pierre Lahoud, Software Development Manager, Bankers Assistance, says: “The successful implementation will help encourage all our medical service providers to support the solution.” In addition:

n Hospital patients have insurance policies verified in seconds, rather than up to 20 minutes.

n Patients feel less stressed because they don’t have to travel, and decisions are made faster.

n Bankers Assurance doesn’t need as many personnel working onsite at hospitals to support the verification process.

n Hospital workers can verify policies faster, thus avoiding bottlenecks when large numbers of people come forward for treatment.

n Hospital personnel feel more in control of their workloads. They can check a claim in seconds.

n IT personnel at Bankers Assurance find the new architecture based on BizTalk Server easy to maintain.

n Bankers Assurance has peace of mind that Microsoft has a long-term commitment to BizTalk Server.

n Reconciliation between the third-party administrator and medical providers can be achieved faster.

n Hospital employees don’t need to learn many systems.