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Virtual Benefits Administrator: Cloud-based Administrative Processing Solutions for Healthcare

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Rich Pierce, CTO, Virtual Benefits AdministratorRich Pierce, CTO
Historically, vendors provided healthcare payers with on-premise enterprise applications architected to support the specific administrative requirements of customers. It is a testament to the lack of flexibility of many vendor solutions forcing payers to maintain aging and legacy core applications. This strategy has resulted in capability redundancy, excess infrastructure costs, and operational inefficiency. The administration space is experiencing a paradigm shift that is in-line with on-ground realities such as the growing number and complexity of government regulations. As a result, CIOs are seeking out administration solutions that are more agile, intelligent, and affordable. This includes more personalized benefits plans, increased coordination between payers and providers, management tools to help payer members, and real-time interoperability within the administration system.

Virtual Benefits Administrator (VBA) is a leading cloud-based medical claims adjudication and administrative software organization that provides cloud-based solutions to payers and third party administrators (TPA). In addition to its commercial client base, VBA caters to payers that support government programs like Medicare, Medicaid, Medicare Supplement, and Medicare Advantage.

VBA’s main focus in the HR landscape is to increase the adoption rate of the self-service capabilities of its enterprise web application platform— VBAGateway—among members of TPAs and healthcare plans. The platform has been designed with a focus on user-friendliness and engagement through the combination of real-time organizational communication and gamification. With VBAGateway, an administrator can experience real tangible savings allowing for more flexibility in pricing and product offerings.
When a TPA or healthcare payer adopts VBAGateway, they will be assisted by backroom IT services and business service teams. The two help train the client to take advantage of all the features in the application and assist them in interface management processes pre and post go-live.

VBA’s other offering, VBASoftware provides core administration support for all types of benefits administration such as commercial, government, medical, ancillary, and health reimbursement while also simplifying licensing. “We have a tagline in VBA—empowering users through configuration; not through customization,” says Rich Pierce, CTO of VBA. Users can steer through the system with configurable hyperlinks and options that maximize effectiveness. Customers can activate only the services that they need, without additional software expenses. VBASoftware supports auto-adjudication, premium billing options, enrollment in any number of customized plans, and real-time claims payment (RTCP) facilitated by VBAGateway web portals. VBA performs all ongoing IT functions related to inbound and outbound interfaces as part of the package.

J.P. Farley Corporation, a privately-held TPA and consulting firm approached VBA over frustrations with their existing software as it was inefficient and could not accommodate a large, new client. VBA implemented its cloud-based administration software paired with VBA Business and IT Services. Utilizing the platform, J.P. Farley Corporation was able to benefit in a number of ways including a modern, user-friendly, cloud-based solution that provided superior customer service and the ability to comply with state CMS filings and encounter reporting.

Since 2009, the company has rebranded itself from a TPA to an entirely software-focused company experiencing tremendous growth at a rate of 46 percent year-over-year and was listed in the Gartner Market Guide for U.S. Healthcare Payers’ Core Administrative Processing Solutions. This year VBA plans to launch two new products—a mobile app powered by VBAGateway in the first quarter and in the fourth quarter of this year, it plans to launch a fully-analytics dedicated platform called VBAnalytics that will be able to integrate with any of VBA’s products. VBA is also excited for its Artificial Intelligence engine called ‘VBA Intelligence’ that will leverage Amazon’s SageMaker platform to predict regulatory changes and feed information into what the experts at VBA are calling ‘hyper-accurate administration.’