Implementation of new standards and data formats always presents a challenging task to an established payer system. Our experienced team helps our clients face those challenges easily.

Client:

A statewide health plan

Project Definition:

Calibration and re-engineering of an existing claim processing environment to meet newly released standards and protocols required by its national claims processing agreement. More specifically, this included:

• Upgrade and modification of the claims exchange subsystem
• Enablement of the in-house claims system to accommodate new processing standards
• Integration and mapping of the new system into the existing enterprise environment

Project Complexities/Deliverables:

• Design a modular standalone solution, leaving the in-house environment intact
• Develop a flexible and highly maintainable design in anticipation of future changes to business rules
• Automate complex claim reprocessing and adjustment logic
• Plan and implement a complex conversion process, which had to occur within a 48-hour window of opportunity
• Manage resources from multiple organizations and 3rd party vendors at various geographic locations

Project Technologies:

• IBM S/390
• CICS
• Cobol
• DB2
• EZTRIEVE PLUS
• JCL
• SAS
• VSAM