Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
The Client is a leading health payer based out of US. Client was using the legacy systems for on-exchange and off-exchange enrolments. Client wanted to modernize their existing systems to process applications from various channels including CMS, online sales, paper based, from agents and private exchanges.
Client Need
Build an enrollment system to accept and validate large volumes of applications
Assign an incoming enrollment application to existing members based on their availability and generate new member IDs
Validate large volume of enrollment applications at the rate of 10k per hour during the open enrollment period
Integrate with third party applications to generate policy fulfillment kits and improve the ID card generation rate to speed up the process
Solution
Built a pre-enrollment orchestration process to identify incoming application type and removes duplicates from processing
Implemented multithreading in Windows services to process large volumes of CMS applications
Implemented a member match logic with 5 sets of rules and a logic to accommodate U65 and O65 data in member match and member ID generation
Built a configurable business rule engine with 120+ member eligibility and application data validation rules from Federal, State and Payer sources
Implemented asynchronous communication to increase the application performance
Enhanced existing integrations with third-party systems (Silver pop, RR Donnelley, Fiserv, etc.) from a service call to FTP through IBM Content collector
Realized Benefits
Improved the enrollment process and removed duplicate applications, thereby reducing the inventory by 2-5%
Handled large volumes of applications without any issues and processed 10k applications in 1 min 30 sec
Reduction in match exception inventory from 15% to 3%
Reduced manual effort from 21 man-days to 4 man-days
Configurable business rule engine helped in reducing overall rule exceptions from 14% to 4%
Improved enrollment application processing speed from 6K to 18K in an hour
Increased fulfillment kit generation rate by 15%
Improved ID card generation rate from 80k per hour to 320k per hour
Tools & Technologies
Microsoft.net entity framework
Angular JS
Jquery
ASP.Net MVC4
Bootstrap
IBM DB2
Java
Microsoft SQL Server
SQL Server Integration Services
Trending Success Stories
Modernizing Enterprise Data Warehouse for Smarter & Faster Healthcare Insights for a Leading Value-Based Caregiver
Implementing Data Lakehouse for a Leading Biotech Major for Faster, Deeper Insights
Reducing Legacy Data Costs While Migrating 12,000+ Tables to a Cloud-Native Platform
Modernizing Epic and EHR on Azure for Scalable, Secure Healthcare Operations
Ready to Innovate with Us?
Let’s Talk!
Connect with us on social media
Write to us at
[email protected]