Client
Our client provides and administers healthcare benefit plans serving a diverse range of U.S. market segments.
Challenge
The client’s claims processing division manages the validation and payment of insurance claims through electronic forms known as EDI X12 transactions (such as 837, 835, and 834). Their process heavily relied on a legacy “green screen” application — a character-based, text-heavy interface requiring manual input.
For example, when a healthcare provider submitted an 837 form, an employee had to manually enter the details into the green screen system. Similarly, responses like 835 transactions from the insurer were processed manually through the same interface.
This outdated, labor-intensive process caused significant inefficiencies, increased the risk of human error, and created challenges in hiring and retaining skilled staff. Additionally, it resulted in a suboptimal client experience. The organization wanted to accelerate claims processing to secure more profitable yet complex contracts, but the existing system’s limited scalability made this difficult.
Specific challenges included:
- Difficulty recruiting and retaining claims examiners.
- Lack of familiarity among new hires with the outdated adjudication tools.
- Extensive onboarding and training time—up to nine months for new examiners.
- Daily frustrations with the green screen application leading to high turnover.
- Inability to respond promptly to client needs due to manual inefficiencies.
The client required a modern, user-friendly interface to enhance the speed, accuracy, and efficiency of their claims processing operations.
Action
While most EDI X12 transactions (834, 837, 835, etc.) are processed automatically, rejected claims still require manual intervention and troubleshooting. Because EDI formats are not user-friendly, end-users needed an intuitive interface to understand and resolve these issues efficiently.
Prolifics addressed this challenge by leveraging Rocket Software to develop a modern web-based UI layered on top of the existing green screen system. This solution consolidated key information into a single-pane view, allowing users to quickly assess claims and take action. It also combined alerts, comments, and error messages; improved navigation flexibility; and introduced a manager dashboard to allocate work based on availability, skill level, confidentiality, and SLA priorities.
This approach enabled the client to preserve their existing green screen infrastructure while benefiting from a modern web interface. Prolifics supported both the implementation and ongoing management of the solution, including maintenance, support, and security, ensuring continuous operational excellence.
The project was executed in three iterations, with QA and user acceptance testing (UAT) integrated early in each phase. This agile approach allowed rapid feedback loops and progressive improvement. As a result, the solution was delivered on time and under budget.
Results
The new solution revolutionized the client’s claims processing operations by introducing a modern web interface that simplified workflows, enhanced usability, and automated key processes.
Key outcomes:
- 25% increase in employee efficiency, improving overall claims throughput.
- Training time for new examiners reduced from nine months to just three.
- Projected savings of over $2 million in business and IT efficiencies over 3.5 years.
The modernization also introduced several new capabilities previously impossible within the green screen environment:
- Claims Assignment: A new dashboard enables managers to prioritize contracts and assign claims effortlessly. Tasks once managed through manual emails and spreadsheets are now automated, with built-in internal messaging for collaboration.
- Screen Aggregation: Multiple green screens are consolidated into a single interface, allowing examiners to view and act on multiple data points simultaneously—skipping irrelevant steps when appropriate.
- Web-Enabled Functionality: Integrated help features, command explanations, and user guidance improve system usability and reduce dependency on specialized training.
- Reference Data Integration: Key data sources are now presented side-by-side with claims screens, streamlining access to relevant information.
- Advanced Search Capabilities: Users can instantly locate claims, diagnosis codes, examiners, and reference data without manual spreadsheet lookups.
- Comprehensive Audit History: The system now logs a complete audit trail of claims activities, improving transparency and compliance.
- Future Scalability: Built-in frameworks allow for easy extension and addition of new commands and features as business needs evolve.
Technology
Rocket Modern Experience is a robust mainframe modernization platform that transforms legacy green screen applications into intuitive web, mobile, or cloud experiences. By leveraging this technology, Prolifics enabled the client to retain existing mainframe investments while introducing a seamless, user-centric web layer that enhances efficiency and agility.
About Prolifics
At Prolifics, the work we do with our clients truly matters. Whether it’s keeping the lights on for thousands of families, improving access to healthcare, preventing global fraud, or safeguarding supply chains, innovation and automation are at the heart of everything we do.
Unlike competitors who scale projects with additional manpower, Prolifics leverages automation to manage costs, minimize errors, and deliver faster results. Our agile, product-driven approach ensures ongoing value across every stage of your digital transformation—spanning Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity.
