August 2021

Challenge

Where’s the Important Data Stored?

RHC has a customer presence in California, which makes it subject to the California Consumer Privacy Act (CCPA). This gives consumers a series of rights over their personal data held by organizations. Our client’s first challenge was to locate where all its consumer data was stored. Different legacy systems controlled by different departments held the data, and these systems didn’t communicate. That put RHC behind on meeting CCPA requirements, leaving them at-risk for substantial non-compliance fines.

Action

Data Privacy Workshop and Audit Keys to Success

We first conducted a data privacy assessment workshop with RHC and performed a data privacy audit. Prolifics offers this as part of our “CCPA jumpstart.” It includes a data inventory and sampling, applies documentation and architectural requirements, and uses artificial intelligence and machine learning (AI/AL) to find all of a client’s consumer personal data and identify where there may be risk of violating privacy laws.

Result

More Data Sources Discovered

Using our internal tools and accelerators, we discovered 163 different sources of data. RHC only knew about a fraction of these sources. Now it knows where all the consumer data it collects comes from and where it’s located.
Going further – the governance and security connection to privacy

Prolifics considers consumer data privacy to be a part of data governance and connected to corporate security. And we understand that good data is critical to everything a company does. Beyond the jumpstart, we’re helping RHC determine how best to organize, manage and govern all its data and data systems. Based on RHC’s desired business outcomes, we conducted a data maturity assessment to determine how best to structure their data. This included an organizational assessment to help put data policies in place and determine specific employees’ roles and responsibilities around the data.

About Prolifics

Prolifics is a global digital transformation leader with expertise in Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity across multiple industries. We provide consulting, engineering and managed services for all our practice areas at any point our clients need them. Vision to Value. Faster. It’s not just the Prolifics’ tagline, it’s what drives us. Connect with us – solutions@prolifics.com

This retail holding company (RHC) is a U.S.-based parent company to several specialty menswear chain retailers. It has offices and a large consumer base in California, although it is not headquartered there.

About our client, a retail holding company for men’s clothing stores

Challenge

Where’s the Important Data Stored?

Because of RHC’s presence and other criteria in California, it is subject to the California Consumer Privacy Act (CCPA), which gives consumers a series of rights over their personal data held by organizations. Our client, however, didn’t know where all the consumer data it collected was stored. This data was held in different legacy systems controlled by different departments and subsidiary retailers, and the systems did not communicate. As a result, RHC was behind on meeting CCPA requirements, leaving them at-risk for substantial non-compliance fines.

Action

Data Privacy Workshop and Audit Keys to Success

We first conducted a data privacy assessment workshop with RHC and performed a data privacy audit. When a company like RHC comes to us in this situation, Prolifics offers the assessment workshop and audit in what can be called a “CCPA jumpstart.” This assessment includes a review of CCPA, finding the gaps a company faces, data inventory and sampling, as well as documentation and architectural requirement as a platform towards compliance. This can include employing artificial intelligence and machine learning (AI/AL) to find the consumer personal data wherever it lives and identify where data may be at risk of violating privacy laws. We can also apply data management processes and procedure solutions to help a company assemble and format this personal information into a digital catalog.

Result

More Data Sources Discovered

Using our internal tools and accelerators, we discovered 163 different sources of data. RHC was aware of only a fraction of these different sources – but now it knows where all the consumer data it collects comes from and where it’s now located.

Going further – the governance and security connection to privacy

Prolifics believes that consumer data privacy is part of data governance and directly connected to corporate security. And we understand that good data is critical to everything a company does. So, beyond a CCPA jumpstart, we are taking the bigger picture step of helping RHC determine how best to organize, manage and govern all its data and data systems to get the most out of it – also known as data maturity. Based on the business outcomes RHC wanted, we conducted a data maturity assessment to determine how best to structure their data. This included an organizational assessment to help them put data policies in place and determine specific employees’ roles and responsibilities around the data.

About Prolifics

Prolifics is a global digital transformation leader with expertise in Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity across multiple industries. We provide consulting, engineering and managed services for all our practice areas at any point our clients need them. Vision to Value. Faster. It’s not just the Prolifics’ tagline, it’s what drives us. Connect with us – solutions@prolifics.com

A “Layer Cake” of Modernization, Integration and Automation

Our client is the publicly traded holding company (HC) of seven insurance companies. They offer Medicare supplements; annuities; and life, long-term care, accident and health insurance to working-class families and senior citizens.  

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, exposing HC and its subsidiaries to substantial fines and penalties, as well as potential negative publicity. 
• The system was batch- and schedule-based, in this case meaning it could only process claims received (transmitted from healthcare providers) by a specific time – 7 a.m. 
• The claims themselves went through a three-hour, multi-step process that was both unwieldy and error prone. 
• HC was facing the possibility that the could lose control of their data – both within the process itself (e.g., they were unable to reconcile claims coming in with claims paid out) and with the inability to meaningfully analyze the data for any other business purpose.

Action

When we sat down with HC and asked them to walk us through their claims processing management system, we identified two fundamental problems: one with modernization / interoperability, or the way HC’s systems accepted data from other organizations; and another with modernization / integration, or the way HC dealt with its own data.  

Automation for Claims Processing

We tackled the interoperability problem first, and our initial step was to move HC from the batch- and schedule-driven system to an event-driven system. An event-driven system’s catalyst is an incident – in this case, a claim’s arrival – rather than an arbitrary demarcation, like a time, (e.g., 7 a.m.) The processing would begin immediately upon a claim’s arrival – it would not have to wait to be batch processed.  

A Clear View of Data Through the Cloud

Then we turned to integration, and, together with HC, determined how to best organize the massive number of incoming claims they received on a daily basis. The client needed control over their claims data, including ease of filing and retrieval, and the capability to readily manipulate data for reports. We recommended they utilize our tech partner Mongo for a cloud-based database. 

At this point, HC’s systems were efficiently interacting with outside organizations and their data was well organized. However, even the most carefully organized data is useless if it lives in a “black box.” So, we provided HC with a global transaction monitor (GTM), which essentially builds a window in the side of that black box. The customized GTM we built for HC is an easy-to-read, easy-to-use, centralized dashboard that allows them to watch a claim make its way through their system. 

Result

Reduced Processing Time

As a direct result of working with us, HC is now HIPAA-compliant, and the organization is in no danger of incurring fines.  

Faster Claims Processing

The implemented event-driven system is a more modern, logical approach to data processing that allows HC greater flexibility in communicating with outside organizations. Because of this efficient automation, the three hours needed to process claims has been reduced to a mere 18 minutes. 

Better Control Over Data

HC now has control of their data. What we’ve ensured through the Mongo database and the global transaction monitor (GTM) is that HC has a full audit trail and traceability for everything that comes into the organization digitally and then goes out digitally. We’ve set up digital record keeping for them as part of our solution, one that’s easy for the business units to use in a dashboard format. So, if someone questions a claim, CNO has the original claim, what it looked like, when it was sent, the file name, where it is located, when it arrived and more – the complete digital audit trail, in just a few clicks. 

If a claim is flagged for any reason — incorrect data, compliance error, etc. — the dashboard alerts the claim services employees using a color-coded system. The dashboard also has reporting and filtering functionalities that allow HC to easily access their data and export it into familiar Excel spreadsheets, where it can be sliced and diced into any format they need.  

This modernization and integration project was so successful that HC has asked us to apply these concepts to other aspects of their business.  

Technology

IBM technologies became the foundation for fixing HC’s interoperability and integration issues. (Prolifics is an IBM Platinum Business Partner.) The first component was IBM’s MQ Advanced middleware. This solution allows HC to manage large (and growing) volumes of data with high availability and extra security; and share that data across any environment with ease.

Honda Bhyat, Prolifics Sr Advisor, Integration and Digital Transformation (DX) Practice, said, “The MQ layer provides the robust connectivity, security, and communication mechanism that transports the data correctly once, and once only, with integrity, tracing ability and visibility. It’s the communication fabric to interoperate all the different HC microservices and pass the data between these services.”

The second component, or layer, is the IBM Transformation Extender Advanced (IXTA). This is a document transformation software – a transaction-oriented, data integration solution that automates the transformation of high-volume, complex transactions without the need for hand-coding. Specifically for HC, IXTA is scalable, flexible, and supports HIPAA with the integration of data from multiple technologies across the company.

Bhyat said, “For HC as a payor, this second layer provides all the intelligence of transforming the data from what it is in – the HIPAA format that the internal systems need – to the formats needed to communicate information to the banks, which are external. Whenever there are compliance audits or questions, we can say yes, we use the IBM tool. It provides all of that compliance checking and compliance reporting and validation.”

For the cloud-based database, we recommended our tech partner Mongo. HC’s prior system was made up of traditional, relational databases. Relational databases break up data and organize similar data into tables. For example, one table would hold names, another might hold birthdates. Someone in the claims department using a relational database would have to pull all those individual pieces of information (or request an IT query for that information) to get a full picture of a policy holder.

About Prolifics

Prolifics is a global digital transformation leader with expertise in Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation and Cybersecurity across multiple industries. We provide consulting, engineering and managed services for all our practice areas at any point our clients need them. Vision to Value. Faster. It’s not just the Prolifics’ tagline, it’s what drives us. Connect with us – solutions@prolifics.com