Our client is a health insurance company (HIC) that has operated in New York State for more than 80 years, evolving with our nation\u2019s healthcare system along the way.<\/p>\n
HIC was experiencing issues and limitations with its current electronic data interchange (EDI) set-up \u2013 the computer-to-computer exchange of insurance documents in a standard electronic format. First and foremost, HIC analysts were plagued by the fact that many health claims files simply never arrived \u2013 there was no exchange at all.<\/p>\n
When HIC did receive files successfully, they were difficult to monitor and track, and were often subsequently lost in HIC\u2019s systems. Files were prone to errors, with data quality obviously suffering as a result. HIC suffered wasted time and resources.<\/p>\n
HIC originally met with other EDI solution vendors. However, based on an IBM referral and our mix of quality, cost-efficient onshore and offshore developers, HIC chose Prolifics.<\/p>\n
We initially engaged with HIC through workshops and demos. Based on those results, we introduced HIC to our Healthcare Integration Kit, which leverages the technologies needed for a configurable integration platform. This solution armed HIC with the EDI processing and monitoring features it needed.<\/p>\n
HIC already had most of the solution infrastructure in place. Prolifics only needed to add IBM Transformation Extender Advanced (ITXA), a document transformation software.<\/p>\n
The final part was a nine-week QA and user acceptance testing (UAT) phase, where our resources worked side-by-side with HIC\u2019s QA division to carry out testing.<\/p>\n
As no additional training was needed, the Prolifics solution proved to be a quick and easy fix for HIC\u2019s issues.<\/p>\n
In total, the solution will save HIC an estimated $1M in software and services costs. The solution is expected to reduce the turnaround time for issue resolution. It will create more visibility into the insurer\u2019s systems and improve the quality of its data. HIC\u2019s analysts can be more proactive, addressing issues before they can snowball into much larger problems. Previously wasted analyst time can be reallocated to higher level work.<\/p>\n
The Global Transaction Monitoring (GTM) component of the Healthcare Integration Kit proved to be one of the biggest upsides to the solution. It provides the real-time monitoring of messages, event processes, and transaction completion throughout the transaction lifecycle. Additionally, when an error is identified in a file, it can be corrected directly from the GTM dashboard rather than having to open up the entire claim file.<\/p>\n
We used the following technologies to help fix HIC\u2019s issues and have them reach their goals.<\/p>\n
Prolifics is a global digital transformation leader with expertise in cloud, data and analytics, DevOps, digital business, and quality assurance across multiple industries. We provide consulting, engineering and managed services for all our practice areas at any point our clients need them \u2013 giving them fast, complete solution delivery experiences that they find nowhere else. Whether it\u2019s initial advising and strategy; design and 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\u2019s healthcare system along the […]<\/p>\n","protected":false},"author":34,"featured_media":29541,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[69],"tags":[],"class_list":["post-4097","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-case-studies","has-post-title","has-post-date","has-post-category","has-post-tag","has-post-comment","has-post-author",""],"acf":[],"builder_content":"","_links":{"self":[{"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/posts\/4097","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/users\/34"}],"replies":[{"embeddable":true,"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/comments?post=4097"}],"version-history":[{"count":0,"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/posts\/4097\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/media\/29541"}],"wp:attachment":[{"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/media?parent=4097"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/categories?post=4097"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/prolifics.com\/usa\/wp-json\/wp\/v2\/tags?post=4097"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
implementation; or ongoing analysis and guidance, Prolifics helps companies take charge of their digital future. Vision to Value. Faster. It\u2019s not just the Prolifics\u2019 tagline, it\u2019s what drives us. Email solutions@prolifics.com <\/span><\/a>or visit us at prolifics.com<\/a>.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"