(September 9, 2002) - With 135,000 members across Massachusetts, Neighborhood Health Plan (NHP) faced two tough challenges. First, NHP needed to leverage the Web to automate patient referral and eligibility processes and provide accurate information to its members and providers. Second, with deadlines fast approaching, NHP sought to provide compliance with transactions and privacy regulations defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for its providers and members. NHP turned to Novell eXtend to meet these challenges.

NHP deployed eXtend Composer, Novell's XML integration server, to create a Web service-based interface between NHPnet.org and the New England Health Electronic Data Interchange Network (NEHEN). The link allows NHP's community healthcare providers to access the Medicaid eligibility information that resides in NEHEN via HIPAA-compliant transactions through a secure portal interface.

Designed to supplement and eventually replace a proprietary point-of-service system that currently generates responses to Medicaid queries, the new system integrates NHPnet.org with NEHEN's EDI infrastructure to rapidly provide broader, more accurate information to the querying member. The new system also enables a phased implementation of HIPAA, allowing NHP to accommodate different compliance timetables among its community participants.

The NEHEN project is the latest milestone in a series that began with the complete re-design of NHPnet.org, NHP's personalized Web portal that now enables member institutions to automate critical transactions online. NHP leveraged several of the key features of Novell eXtend Director, including its business rules and content management capabilities, to create a robust portal in less than three months. As a result, NHP's member healthcare providers are able to transact referral notifications and eligibility verifications in a secure, reliable environment, streamlining processes that were often tedious and error-prone due to the manual data entry into back-end systems that was previously required.

Since launching the Novell eXtend-based NHPnet.org, NHP's user base has grown to more than five times its previous size, with more than 70 percent of NHP's 120,000 members now being managed through NHPnet.org. Sixty percent of NHP's referral volume now comes through NHPnet.org, which has dropped the cost for conducting eligibility verifications from approximately $8,000 per year in a paper-based system to roughly $200 per year using NHPnet.org.

Eventually, NHP plans to expand its portal's capabilities to include case management and claims status inquiry functionality, as well as integrate NHPnet.org with NHP's corporate Web site, which is currently outsourced. For more information, visit www.novell.com/extend.