This organization is a health insurance plan provider serving several million members.\u00a0\u00a0<\/span>\u00a0<\/span><\/p>\n Processing medical insurance claims is a major part of our client\u2019s business. They serve several million members, and use EDI, or electronic data interchange, to process claims and integrate business documents coming in from a multitude of healthcare providers.<\/span>\u00a0<\/span><\/p>\n Our client felt boxed-in by their incumbent, legacy EDI claims processing system, which had become the \u201conly game in town\u201d for the vast majority of health plan providers. They felt that parts of the system were inefficient and unwieldy, and lacked transparency and flexibility. Also, they felt the cost of the legacy system was not in line with what the incumbent provided, adding a financial component on top of the operational issues. Specifically, our client told us that:<\/span>\u00a0<\/span><\/p>\n The client made its mandate clear \u2013 replace the legacy system.<\/span>\u00a0<\/span><\/p>\n Prolifics knows that to be a fully modern healthcare organization, a plan provider needs to be efficient and customer-centric in its claims processing; with all systems communicating with each other quickly, securely, and in compliance with all regulations. Saving even pennies per transaction will add up to significant cost reductions.<\/span>\u00a0<\/span><\/p>\n The client looked at several different EDI claim processing system providers, and ultimately chose Prolifics EDI Modernization for Healthcare, a modern, open, and cloud-ready alternative to legacy systems. As presented to our client, EDI Modernization for Healthcare:\u00a0<\/span>\u00a0<\/span><\/p>\n The client is switching from their legacy system to Prolifics. The client\u2019s reasons include:<\/span>\u00a0<\/span><\/p>\n \u201cI immediately saw two exceptional capabilities that Prolifics EDI Modernization for Healthcare provides for EDI transactions processing. First, agility \u2013 I can customize the user interface exactly to my business needs. Second, data transparency \u2013 I can clearly follow what\u2019s happening in each step of the EDI transaction process.\u201d\u00a0 M.P., Lead IT Applications Consultant for our client.<\/span>\u00a0<\/span><\/p>\n Prolifics EDI Modernization for Healthcare:<\/span>\u00a0<\/span><\/p>\n The solution is meticulously engineered by Prolifics\u2019 healthcare EDI experts using an off-the-shelf tech stack and includes:<\/span>\u00a0<\/span><\/p>\n Let\u2019s discuss how Prolifics EDI Modernization for Healthcare can increase efficiency and cut operational costs in your claim environment. Click here to <\/span>connect to an expert<\/a>.\u00a0<\/strong><\/p>\nChallenge<\/h4>\n
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