Faster Claims, More Control a Victory for Insurer and Patients

Chas Jordan

Challenge  Older system can’t keep up with today’s healthcare demands  HC’s claims-processing system was a homegrown, legacy environment — cobbled together using older technology that wasn’t seamlessly integrated. Running and maintaining the system had become untenable, creating several major headaches for the claims payer:  The system had become non-compliant with HIPAA.  The system was batch- and schedule-based.  The claims themselves … Read More

Modern Integration Means Better Data Flow for Distributor

Pam Roman

About our client – and an ongoing journey Our client, a medical and dental supplies company (MDSC), is based in New York State. With more than 25 distribution centers, it ships products around the world. Our original MDSC article involved outdated systems being handled expertly by older, but retiring, employees. MDSC could not attract younger workers for the old systems. … Read More

Insurance Provider Claims Win with Stronger Data Analytics

Chas Jordan

Our Customer This health insurance payer (HIP) works with more than 29,000 healthcare providers across its state, serving 11,000 employer groups and more than 3.5 million members.  The Challenge HIP’s priority is to expand client options and access to key services. Increasingly cost-prohibitive analytics and business intelligence tools, however, put this goal in jeopardy. HIP’s existing analytics and BI platform … Read More

What’s Integration Without Visibility?

Pam Roman

Interoperability – the frictionless, secure exchange of electronic health data – is an ongoing goal for all healthcare organizations, whether payer, provider or otherwise healthcare related. If we define interoperability as being among different organizations, then it all has to start with integration within any one organization. You can’t effectively share with others if your own internal systems are siloed … Read More

Health Insurance Company Expected to Save $1M with New EDI Solution

Pam Roman

OUR CLIENT Our client is a health insurance company (HIC) that has operated in New York State for more than 80 years, evolving with our nation’s healthcare system along the way. CHALLENGE HIC was experiencing issues and limitations with its current electronic data interchange (EDI) set-up – the computer-to-computer exchange of insurance documents in a standard electronic format. First and … Read More

Short-Term Modernization Creates Long-Term Possibilities for Health Coalition

Pam Roman

Prolifics helps Health Coalition with Short-Term Modernization and Long-Term Possibilities Our client, a Health Coalition, is a non-profit organization that connects, collects and integrates health information in an exchange in partnership with its state’s department of health. Participating healthcare professionals (with patient consent) can access electronic health information and securely exchange data with other state participants. This improves patient outcomes, … Read More