To Batch or Not to Batch? That is the question.

To Batch or Not to Batch? That is the question.
George Hislop, AVP of Consulting – December 5, 2014

I can’t count how many times I’ve heard that healthcare is 20 years out of date with current technology. One prime example of this is batch processing transactions for enrollment, claims processing, and systems integration. Certainly the technology exists to allow us to change how both internal and external systems communicate with each other. So, what are we waiting for?

It’s not as easy as one would think. Many software vendors provide restful and SOAP connectors for their products. However, the use of these products comes with an additional price tag. Even if the vendor didn’t charge for the "new" service, you still need to expose it to the group that is providing the claims. This means designing, developing and securing an infrastructure which is HIPAA compliant. Certainly with virtualization and most companies already having some form of web presence the cost to do this has decreased but it is still not trivial.

Next question is who will be in a position to benefit from this exposed infrastructure? Surely a provider might see the advantage of getting immediate adjudication of a patient's medical claims. How great would it be for them to know the patient's responsibility before they leave the office, find errors in claims and correct them in hours not months? Pretty cool, right? Still, most providers send claims data in x12 flat files to either clearing houses or directly to insurance payers. And, if it’s going through a clearing house or if the plan is leveraging off-shore resources for data entry, it adds a whole different layer of complexity. That begs the question- if I build it who would use it?

So, we’re stuck with batch-at least for now.

Even though the technology is well over 20 years old and not used by many other sectors, we’re stuck with batch and the dreaded batch window. Batch windows are tough because if not carefully managed they can creep in and slow down daily processing of the business units and increase operation costs. In order to avoid batch slowdowns/failures batch performance must be constantly monitored with a mitigation plan in place which requires discipline and manpower.

Does this mean we should abandon Real Time alternatives to batch? No. But it probably makes the most sense to first assess internal opportunities for interactive integration and then start moving forward with key relationships where controlled and measurable benefits can be realized.