Background

One of North America’s largest health plan providers needed expert solutions to complex digital problems.

In a long-term engagement with Object Edge, they looked to modernize and restructure their company to set it on track for digital maturity.

The Challenge

High maintenance cost with the existing, inflexible architecture/design
Lack of traceability for messages processed by platform
Systems not extensible to accommodate new mandates
Need to revamp backend system, depending on rebuilding and creating a strong EDI foundation

Our Approach

Our Business Analysts and Business Architects brought a deep understanding of the healthcare payer and provider issues. Technology Architects have solved architecture and design issues for the healthcare domain by using industry patterns with customizations.

For these complex enterprise organizations, our experience includes:

Business Architecture and Technology Architecture for e-business channels
End to end delivery of enterprise-wide EDI channel, HIPAA compliant
Enrollment
Claims
Eligibility Request-Response
Claims Status Request-Response
Authorization
Remittance Advice
Premium Payment
Enterprise Resource Planning (ERP) integration
e-Prescription Technology Architecture
Integration architecture for national network of hospitals
Enterprise Architecture IT governance model
Support for architecture, design and development of ESB
All aligned with HIPAA compliance

The Results

Deep understanding of the challenges and technologies for modern, digital, healthcare services, including:
Built tools and accelerators, designed for the healthcare space, to deliver quality solutions on an accelerated schedule
Best shore mix: on-shore expert business analysts and technology leaders to ensure shoulder-to-shoulder partnership with our clients, plus near-shore and off-shore support teams to provide value for maintenance of the healthcare solutions