Scaling out
Client:
One of the largest dental insurance companies nationwide
Problem:
System could not handle very large enrollment files.
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Solution:
Created enrollment front-end to accept very large member files in EDI file format X12 834, scrub & validate data, then pass it to the main enrollment system.
Data Transformation
Client:
Large Health Insurance Company
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Problem:
The proprietary in-house system produced non-standard XML files that contained multiple sub-files in a format incompatible with the EDI system. To become compatible, the in-house production system would need to be reprogrammed, requiring approximately seven months of engineering.
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Solution:
Created a custom file splitter in about 3 weeks, and the production system did not need to be modified.
System Performance
Performance Gains
Client:
Integrated health plan and care delivery system for Medicare and Medicaid patients
Problem:
Customer's developers didn't fully understand the EDI system, and created a claim preprocessing system that was extremely slow - 20 hours to process 150,000 claims. The business could not operate effectively.
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Solution:
Original design was scrapped and it was rebuilt with a new architecture in 4 weeks, reducing the processing time for 150,000 claims to 20 minutes.