Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
The client is a diversified, multi-national FORTUNE® 50 major health insurance provider in US, providing various health insurance plans under Medicaid, Medicare and commercial line of business
Client Need
Integration of Claim, Member, Provider, and Clinical data from each health plan to the corporate RTR structure
The CMS Interoperability Mandate is a significant requirement on the RTR program, which got initiated on 07/01/2021
The process needed to be appropriately designed and implemented without affecting other health plan timelines and had to meet the CMS mandate deadline
Coordination was required among the individual teams to push the data to RTR in the specified format
Solution
Developed multiple stored procedures to map the logic with the JSON fields and generated the JSON using .NET application
Optimized the process to push JSON messages to downstream within the run window and implemented the logging mechanism for effective monitoring
Designed Automic workflows to source the data every 15 minutes and push it to RTR via API/Kafka Topic
Created an automated process to report JSON schema errors and to notify business teams via email
Realized Benefits
Successfully integrated the health plan data as per the business need and timeline
Created reusable components to be reused across the streams (Claim, Member, Provider, and Clinical) and achieved the optimal performance in all the streams
Implemented error reports for reconciliation and to notify the business immediately
Built robust process for initial and synchronous hydration handling up to 200 million records optimally
Data is available for downstream applications to fetch member and provider details via APIs and useful for functional migration and channel applications
Tools & Technologies
Sybase
Greenplum
ORACLE
Microsoft .NET
IBM Datastage
Kafka
Atomic
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