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 The Client
A leading, full-service medical management organization committed to delivering innovative methods of healthcare cost containment through utilization management, case management, total health programs, eligibility verification, and pre-treatment authorization services.
Services Provided
Application Architecture and Strategy  Integration Architecture and Strategy Advanced Software Development Project Management
The Business Situation
In the healthcare continuum, our client is positioned between providers and payers/TPAs. Responsible for eligibility verification, pre-treatment authorization, and management of employer-based healthcare programs, our client routinely processes and manages high volumes of patient and policy data. Security, data integrity and data accuracy are critical to their processes and business. Their existing business process management application was difficult to manage, prone to data loss, and overly complex. The results were delays in realizing revenues, launching new products, and higher costs of operation.
To further their leadership position within the industry and support future business and revenue growth, they required that the existing application be replaced by a robust, highly scalable, high-performance platform. The solution had to integrate with their proprietary utilization management software, allow for rapid and simple client set-up, consistently process the patient eligibility data on which their services are based, and provide HIPAA compliant security.
Our Work
Utilizing our Architecture FirstSM approach and agile methods, X by 2 architected a "fit to task" solution that was a combination of 3rd party, "off -the-shelf" products and X by 2’s integration platform customized to our client’s needs.
The X by 2 Integration Framework (XIF) allows our client to receive high volumes of non-uniform data from eighty or more insurance carriers. Data is translated and moved into their proprietary system where they can quickly and easily update/verify eligibility and process authorizations for medical procedures and services.
The framework includes "plug-in" capability for the addition of future applications, and fully integrates with our client’s proprietary utilization management software. Client setup is simple. Visual tools map and support highly complex proprietary or standard file formats such as EDI834, X12 standards, and XML standards such as ACORD and HL7.
Benefits Realized
- Reduced new client set-up time from 2 months to a matter of hours, improving revenue realization
- Improved customer service through streamlined processes, robust error detection, correction, and diagnostic capabilities
- Business SMEs can manage data without the need for IT professionals
- Flexible, yet simple, architecture that increases speed to market of new products
- Solid foundation for business growth, organic as well as acquisitions
- Reduced Total Costs of Ownership - initial implementation, extension and evolution, and maintenance and support
The Technology Landscape
Windows 2000, .Net (C#, ASP.Net), SQL Server DB, BizTalk, XML
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