Best Practices for Gateway EDI

Posted by Mark Brousseau

For Gateway EDI, EHNAC accreditation shows the way to best practices. EHNAC Executive Director Lee Barrett explains:

As one of the fastest-growing providers of healthcare electronic data interchange, Gateway EDI processes transactions for more than 10,000 medical offices representing 50,000 providers in all 50 states. Gateway EDI also connects to more than 3,000 payers and offers services ranging from standard claims processing and status reports to more advanced capabilities such as technology for flagging rejected claims.

Founded in 1983, Gateway EDI has continuously pursued innovations, business practices and opportunities to improve its services. In 2006, just such an opportunity arose through a relationship with the Electronic Healthcare Network Accreditation Commission (EHNAC).

“Our initial interest in EHNAC was prompted by a state of Maryland requirement,” recalls Dave Cheli, chief information officer, at Gateway EDI. “But the accreditation process proved to be a real eye-opener for us.”

An industry veteran, Cheli was already familiar with EHNAC’s work, which dates to the early 1990s. Though the Gateway EDI team knew generally what to expect, they were pleasantly surprised with the advantages of achieving full accreditation in March 2006.

“It provided a great framework for bringing together a wide range of security, privacy and operational aspects,” says Cheli. “Seeing it all from EHNAC’s perspective in a comprehensive overview was an interesting experience. It shined some light on some aspects of our business where there had been missing pieces.”

Taking a closer look
Transaction auditing serves as a case in point. Gateway EDI manages more than 15 million transactions a month, and the EHNAC criteria require that electronic health networks demonstrate the ability to produce detailed audit trails for all of them.

“Most clearinghouses handle millions of transactions on a monthly basis,” says Cheli. “You might think you can account for every transaction, but EHNAC forces you to show that you can. When you start looking at reports and doing the research, you learn more about your business. For us, the process highlighted some areas where we were able to shore up our capability to reconcile every single transaction.”

In addition to these operational enhancements, EHNAC accreditation has impacted the customer service side. “As a result of our original accreditation in 2006, we added some processes that have benefitted our clients, such as closer monitoring of customer service status,” says Cheli.

In response to marketplace trends, Gateway EDI has grown its business on the strength of value-added services and strong support. And in the years since it began working with EHNAC, Gateway EDI has further built on that advantage. In May 2008, Gateway EDI was included in the “Ambulatory EDI Claims Clearinghouse” report published by KLAS, the Orem, Utah-based research firm (www.KLASresearch.com) specializing in monitoring and reporting the performance of healthcare vendors.

Gateway EDI’s results included 100 percent positive commentary regarding the vendor relationship, and perfect scores, 100 percent, for Would Recommend to a Friend or Peer, and Services Delivered within Budget/Cost. With most Gateway EDI customers “feeling well taken care of”, Gateway EDI earned an 89 overall rating score, a functional strength rating of 4.5 out of 5.0., and first-place for practice management integration. It also captured the top rating in several categories, including “Quality of Services Staff” and “Real Problem Resolution.”

Standards as best practices
As a self-governing non-profit, EHNAC maintains a comprehensive set of publicly-available standards criteria covering privacy and confidentiality; technical performance; business practices; physical, human and administrative resources; and security.

The EHNAC standards development process is fully open and transparent. Based on years of research, it’s the result of continuous input from electronic health networks, payers, hospitals, physicians, consumer groups, financial services firms, security organizations and vendors.

“Because it’s built on years of studying the industry and it’s so broad based, the EHNAC criteria have essentially become a collection of best practices,” says Cheli.

A credible process
EHNAC’s accreditation process, which is based on these established standards, begins with a candidate organization’s submission of an in-depth self-assessment. Later, an EHNAC site reviewer visits to evaluate the accreditation candidate more closely. This hands-on approach helps companies identify issues as well as opportunities.

“In 2006 and again, with our re-accreditation in 2008, the EHNAC assessor spent time understanding our processes. They’ve asked a lot of insightful questions and shared some wonderful tips with us,” says Cheli. “For example, this year we got some very valuable advice on improving our disaster recovery and business continuity measures.”

An operational catalyst
Cheli believes that EHNAC has served as a sort of catalyst, helping Gateway EDI expand privacy and security measures, make decisions about business practices and set meaningful operational objectives. “We now have a lot of people setting departmental goals and monitoring performance metrics that are built around EHNAC criteria,” he says. “Getting a set percentage of claims out in a certain time frame, for example, is now crystallized for us as a monthly goal. And we’re more meticulous about monitoring against those goals.”

“Would we have gotten there without EHNAC driving a lot of this?” Cheli asks. “Probably. But not as quickly. EHNAC is the only organization that provides a comprehensive accreditation service for clearinghouses. HIPAA-related issues are just a part of the overall criteria. They look at it from a total operational perspective.”

Truth in advertising
One also can see the results of Gateway EDI’s efforts with a quick visit to its website. Gateway EDI customers have an average overall error rate of only seven percent. Ninety-eight percent of customer service calls are answered directly by a real person. Gateway EDI solves 92 percent of customer questions on the first call.

And prospects can rest assured that these claims about claims are real. In addition to performance standards and policies and procedures, EHNAC accreditation encompasses “truth-in-advertising” criteria. So statements like these are verifiable.

What began as a requirement has become a resource for Gateway EDI — and relationship, too. “The people behind EHNAC are experienced, smart and very passionate about what they do,” says Cheli. “They’ve been extremely supportive of us, and our relationship has been wonderful.”