April 2022

medic carrying hospital gurney at emergency

Faster Claims, More Control a Victory for Insurer and Patients

Faster Claims, More Control a Victory for Insurer and Patients

A “Layer Cake” of Modernization, Integration and Automation

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 went through a three-hour, multi-step process. 
  • HC could not 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.  

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– in this case, a claim’s arrival. Processing would begin immediately upon a claim’s arrival – it would not have to wait to be batch processed.  

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

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

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. 

HC now has control of their data. What we’ve ensured through the cloud 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, HC 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. 

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

Technology Summary

The GTM solution is built with the latest and newest technologies: IBM MQ Advanced, Mongo document-centric database, Python programming language, and IBM Transformation Extender Advanced (ITXA) when HIPAA compliance is needed. Prolifics provides its unique implementation expertise to build custom data transformation maps and orchestration for the customer process workflows. 

“You can think of this project as a layer cake. The first layer was MQ, the second layer ITXA, and the third the new cloud database. Prolifics brought the icing with the global transaction monitor (GTM) and data visibility.”

Honda Bhyat, Prolifics Sr. Advisor, Integration and Digital Transformation

Access the expanded version of this success story and its technology to learn more or reach out to us a solutions@prolifics.com.

expanding IBM footprint-01

Protecting – and Expanding – the IBM Footprint with Cloud Paks

Insights from Greg Hodgkinson, Prolifics CTO and IBM Lifetime Champion 

IBM’s Cloud Paks provide the perfect delivery platform for us as a digital engineering company, where we aim to simplify the complex solutions our customers need. We partner with IBM – again and again – with proven business outcomes on Cloud Paks for customers across retail, finance and healthcare – guiding their journeys all the way from proof-of-concept (PoC), through implementation and into production.  

We are the experts in taking on-prem, traditional IBM platforms to the cloud. Need to move from IIB to ACE? We’re the best! We have a dedicated expert migration factory that gets them onto ACE and to the cloud with Cloud Pak for Integration, with a step-wise approach that is low-risk, and a skilled offshore team to bring low-cost. You’ll find that we know the Cloud Paks – for Data, for Integration, for Business Automation – inside and out, from big picture to hands-on-keyboards. IBM footprint continues, in the cloud! 

What’s next? As the Paks grow, so do we. We’ve a recent PoC success with IBM Cloud Pak for Watson AIOps, proving the proactive automated anomaly detection with a customer’s own systems and data, reinforcing the value in their terms, and getting them to commit to a pilot rollout. Let us do the heavy lifting to prove out the business case for your prospects! It’s all part of what we do as an IBM Platinum Business Partner. Connect with us and we’ll be happy to share Cloud Pak success stories – and get ready together for your next customer.  

gregory.hodgkinson@prolifics.com 

Business colleagues clapping hand for there colleague for the success in the auditorium stage

Prolifics Earns Two Coveted World HRD Congress Awards

Hyderabad, INDIA, April 2022 – Prolifics, a global digital transformation leader, is proud to announce it received two awards at the 30th edition of the World HRD Congress, held two weeks ago in Mumbai, India.

The World HRD Congress honours top initiatives in human resource practices. Prolifics’ awards are:

  • Award for Best Talent Management
  • Award for Innovation on Learning and Development (L&D)

Satya Bolli, Prolifics Chairman & Managing Director, said, “We’re excited to have received these awards. They reflect our dedication to recruiting, training and keeping the best people, and is part of our commitment to making Prolifics the IT employer of choice.”

Prolifics is a perennial World HRD Congress award winner, with recent company wins for “Best Employer Brand,” “Best Leadership Development Program,” and “Best Workplace Practice,” as well as individual awards for our HR personnel.

Partha Patnaik, Prolifics Global Head of Human Resources, said, “Prolifics is consistently rated as a ‘Dream Company to Work For’ in our industry. We’re proud of these accolades – it means we’re getting great talent to come on board with us, and success breeds more success.”

The World HRD Congress is an independent and not-for-profit organization governed by an advisory council. Its stated purpose is to make “work and working lives better.” The World HRD Congress looks to make a real difference to the HR community, business and the economy.

Prolifics is always looking for the best and brightest. Start your career as a “Prolifian” here.

About Prolifics

Prolifics is a digital engineering and consulting firm helping clients navigate and accelerate their digital transformation journeys. We deliver relevant outcomes using our systematic approach to rapid, enterprise-grade continuous innovation. We treat our digital deliverables like a customized product – using agile practices to deliver immediate and ongoing increases in value.

We provide consulting, engineering and managed services for all our practice areas – Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity – at any point our clients need them. Email solutions@prolifics.com or visit us at prolifics.com.

Media contacts:

Pamela Roman at Pamela.Roman@prolifics.com, US- 1 (818) 877-0073

Sharath Rahula at Sharath.Rahula@prolifics.com, INDIA +914067771633

Young female lawyer during work in chamber. Gavel and Themis statue on the brown shining desk.

Court System Runs Smoother with Business Automation

Our Client

A state government office needed to prevent delays in the Administrative Office of the Courts (AOC) to better fulfill the administrative responsibility of the courts.

Challenge

A State Administrative Office of the Courts (AOC) needed to improve the efficiency of making payments to attorneys, interpreters, and expert witnesses in order to support the intent of the courts in upholding the constitutional rights of citizens to a fair and speedy trial. Their current systems had long time delays between screens causing delays in the payment of auditing claims.

One of AOC’s specific goals was to pay claims no later than 30 days from time of submission; however, auditors were working on claims 45 days old. As is a common challenge in the public sector, the existing software platform was no longer supported and could not be upgraded. They needed both a short-term solution to help clear the immediate backlog and a longer-term solution to set them up for future success.

Action

Based on our prior work within the state, Prolifics was able to bring a broader approach and understanding to the program. We balanced the strategic needs of the state’s centralized executive branch with the long-term needs of updating the systems for AOC and identified the best way forward for the courts. 

Initially, AOC had three different applications that performed parts of the claims auditing and payment interface, but these applications were not integrated throughout the department. These systems siloed the information from the attorney, witness, and interpreter claims, making it difficult for judges to review and approve claims online. It was an inefficient, noncentralized system that contributed to the backlog and resulted in inaccurate and unpaid claims.  

Prolifics removed AOC’s dependency on physical paper and the old method of sending claims in via receipts and envelopes. (Many attorneys and expert witnesses were running from case to case and trying to manage the paperwork in their cars between court appointments.) By digitizing the process online and removing the barriers created by the prior systems, the people relying on AOC were able to streamline communications. Prolifics was able to set AOC up with an automated method of catching and addressing claims that otherwise would have slipped through the cracks. 

Results

Prolifics’ business automation created the opportunity for AOC to intentionally allocate resources to better serve the attorneys, expert witnesses, interpreters, and the reviewing judges. Prolifics set AOC up for success by streamlining their processes and setting up a stronger infrastructure capable of handling upwards of 10,000 claims per month.  

The new system reduces the average claim processing time from 45 days to fewer than 10 days, and resolved claims in limbo. Importantly, it now provides transparency and tracking. Before, an attorney or other claimant wouldn’t know where their claim was in the process. But now, with the new reporting capabilities, you are able to pinpoint exactly where the claim is and its status.  

“We’ve named the solution created from this implementation the Prolifics ACAP solution – for ‘administrative claims and payments,’” said Salem Hadim, Head of Prolifics’ Smarter Process Practice. “Our state client has built their website pages around this solution, saying that the new system: ‘…will allow users to more accurately and efficiently input and track claims for payment. The new system will provide users with more feedback and transparency on their claims. The payment process will be streamlined on the backend, improving turnaround times…’ The pages provide registration, training, claims submission, tracking, reminders, videos and more.”  

In addition, by implementing intelligent automation and incorporating artificial intelligence and machine learning (AI/ML), Prolifics has set up AOC for continued efficiencies.  

About Prolifics

Prolifics is a global digital engineering and consulting firm helping clients navigate and accelerate their digital transformation journeys. We deliver relevant outcomes using our systematic approach to rapid, enterprise-grade continuous innovation. We treat our digital deliverables like a customized product – using agile practices to deliver immediate and ongoing increases in value.

We provide consulting, engineering and managed services for all our practice areas — Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity across multiple industries — at any point our clients need them.

Vision to Value. Faster. It’s not just the Prolifics’ tagline, it’s what drives us.  Email us at solutions@prolifics.com or Contact Us

Business process automation concept on blurred network cabinets. New project 2020.

Your Guide to Automation Types

Automation can transform your business, improve productivity, and drive faster growth. But with so many options, it’s hard to know which automation is right for you. This guide breaks down the types of automation and shows how they can benefit your organization.

Why Automation Matters

Automation reduces repetitive work, frees up employees for strategic tasks, and improves accuracy. From simple task automation to AI-driven decision-making, choosing the right level is crucial to success.

Key benefits include:

  • Increased efficiency and productivity
  • Reduced errors and operational costs
  • Better decision-making with real-time data
  • Scalable solutions for growing businesses

Types of Automation

1. Robotic Process Automation (RPA)

What it is: RPA automates repetitive, rule-based tasks using bots or scripts.

Why it matters:

  • Frees employees from manual data entry
  • Reduces mistakes caused by fatigue or boredom
  • Quick to implement – often within 3-4 weeks
  • Low cost and minimal training required

Example use cases:

  • Entering data from documents into systems
  • Re-keying information across non-integrated applications
  • Processing standard transactions

RPA is not meant to replace employees. It empowers them to focus on higher-value work.

2. Intelligent / Business Process Automation (IA / BPA)

What it is: IA and BPA use RPA combined with AI and business process management (BPM) to support knowledge workers and complex processes.

Why it matters:

  • Speeds up decision-making for exceptions or complex tasks
  • Reduces operational inefficiencies and costs
  • Scales up or down based on workload

Example use cases:

  • Healthcare: Reviewing claims for exceptions or suspected fraud
  • Banking: Reconciling accounts or posting journal entries
  • Mortgages: Processing applications and supporting documents

IA/BPA gives employees the right information at the right time, improving accuracy and efficiency.

3. AI-Powered Automation

What it is: AI-powered automation leverages AI/ML to analyze data patterns, predict outcomes, and make decisions automatically.

Why it matters:

  • Handles complex, data-driven decision-making
  • Identifies trends and predicts future outcomes
  • Provides proactive insights for strategic business actions

Example use cases:

  • Predicting loan defaults in financial services
  • Recommending customer purchases
  • Predictive maintenance for equipment

AI-powered automation supports strategic work, enhancing competitive advantage rather than replacing employees.

4. Enterprise-Wide Automation

Hyperautomation: Combines multiple automation tools (RPA, AI, BPM, low-code/no-code) to automate end-to-end business and IT processes.

Extreme Automation: Integrates disruptive technologies such as cloud, AI, blockchain, and NLP across all processes for a new operating model.

Process Mining: Visualizes how data flows through your organization by analyzing digital footprints in systems.

Benefits:

  • Identifies inefficiencies and gaps
  • Ensures compliance and process standardization
  • Guides automation strategies with real data

Process Mining allows businesses to confidently implement automation with measurable results.

How to Choose the Right Automation

  1. Start small: Begin with RPA for repetitive tasks.
  2. Scale intelligently: Move to IA/BPA for knowledge workers.
  3. Leverage AI: Use AI-powered automation for predictive, strategic decisions.
  4. Optimize enterprise-wide: Apply hyperautomation and process mining for maximum efficiency.

How We Can Help

Prolifics offers free discovery workshops to assess your automation needs. Our experts can design, deploy, and customize solutions, from RPA to AI-powered automation, delivering measurable improvements in time, efficiency, and decision-making.

Contact us: solutions@prolifics.com

Learn More About Automation

Join our next Innovation Sandbox: BOTS – Taking on Today’s Challenges. Learn how automation improves healthcare experiences and supports employees’ mental health. Register for the live online event on Prolifics TV.

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Collaborative, DevOps Approach Modernizes​ Systems Quickly

Our Client

Our client is a UK leader in resource management services (RMS) and outsourced recycling services. This is a new client for Prolifics; MuleSoft introduced us. RMS chose Prolifics in part due to our DevOps expertise and hybrid delivery model.

Challenge

Over the past few years RMS has undertaken a massive business expansion – acquiring a lot of other companies to come under their group umbrella.

RMS had been using a monolith legacy application for more than 20 years. While it suited the business well in the past, it’s now reached a state where a simple change – like introducing an additional field – would take considerable time and expense.

In addition to this lack of agility and accommodation, RMS had a looming, drop-dead renewal date on the legacy license itself – with a huge cost connected to this extension.

RMS decided to replace the monolith legacy application system with Salesforce to enable various APIs and other integrations. They then decided to couple Salesforce and MuleSoft.

Action

RMS chose Prolifics based on our DevOps capabilities and our hybrid onshore/offshore delivery mix.

As with any Prolifics engagement, when we go in, we address the immediate needs while still working on the bigger picture. This means immediate value without a project being held up.

We went in for initial discussions on project approach. RMS saw the benefit from Prolifics – rather than just providing a group of offshore developers, we could provide the entire package through our hybrid delivery model. This included the local UK team supported by offshore architects and offshore development capabilities.

The first part of the engagement was understanding what RMS had and what the actual requirements were. So, we went through that inception phase to understand:

  • What used to get done?  
  • What does the technical landscape look like? 
  • What is it that needs to be integrated?

In the phases that followed, a lot of time was spent with RMS as we configured the platform and built the new environment. RMS wanted to ensure that they could do rapid deployments and manage the platform going forward, correcting one of the original problems of changes taking months.

One of the themes through our entire work with RMS was that they had been learning and developing Salesforce at the same time. So, we would come out of phases without a fully signed-off, completed design, because we wanted to be able to work in the agile way. In true DevOps fashion, we wanted to accommodate changes as we were going along – accommodate the changes and the changing levels of knowledge that RMS had as they were going along.

Result

Prolifics is still currently in the implementation phase, with a “big drop and go live” scenario with MuleSoft, Salesforce and all other apps going live at one time. This is not the optimal method, but due to the workings of the legacy system, one large “cut over” is necessary.

To-date benefits include:

  • Overall systems architecture is in place
  • Implementation of reference architecture and platform has been set up
  • Integration of all apps interacting with legacy system to Salesforce, Azure and AWS cloud using new integration platform
  • Documentation of everything in a corporate-based wiki, as well as the MuleSoft platform

After “go-live,” RMS will have:

  • Reduced costs
  • API-led connectivity and reusable APIs
  • Reduced time managing APIs
  • Up to 20 percent time savings for the development of new applications

Prolifics has created the foundation for changes to occur at RMS in a swift and efficient fashion. To find out more about RMS’ transition away from their legacy system, read the full case study.

Read the Full Case Study

About Prolifics

Prolifics is a digital engineering and consulting firm helping clients navigate and accelerate their digital transformation journeys. We deliver relevant outcomes using our systematic approach to rapid, enterprise-grade continuous innovation. We treat our digital deliverables like a customized product – using agile practices to deliver immediate and ongoing increases in value.

We provide consulting, engineering and managed services for all our practice areas – Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity – at any point our clients need them.

Email: solutions@prolifics.com or visit us at prolifics.com

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