| Medicare / Medicaid - Development, implementation
and support of an end - to- end MITA compliant solution
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| Customer |
| The customer is a premier
provider of diversified business process and information
technology outsourcing solutions to commercial and government
clients. |
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| Challenge |
| The major
challenge with our client is Maintenance of Medicaid and
PBM legacy/client server based applications painstaking
for the IT staff. Complex design structures with integration
to more than 40-50 COTS products and lot of external interfaces.
Problems with Member/Provider management, Claims, and
Payment processing. |
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| Solution |
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Developed
an Enterprise SOA based application integrating
MMIS and PBM. Flexible to sell the application as
a whole or as component either MMIS or PBM part
of the application based on state to state requirements.
Formed an Alliance partnership to implement Java
based solution migrating the PowerBuilder and legacy
based application to Web based |
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Automated these
processes with internal components handling the
eligibility and enrollment verification. Reduced
COTS integration |
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Automated Claims
processing for all types of Claims (Institutional,
Professional, Dental and Pharmacy POS). Also automated
payment processing and billing |
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Integrated Disease
management solutions and added Utilization review
reports (Drug/Member) along with Health care services
contracting |
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Enterprise application
adhered to MITA model and all transactions adhering
to HIPAA standards |
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| Benefits |
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Provided
a 24 x 7 real time Enterprise application with entire
claims adjudication/enrollment/eligibility process
integrated |
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Reduced administrative
and training costs |
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The system built
on open standards which are highly configurable
based on state to state requirements |
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Highly scalable
and easy maintenance of the application with Single
sign on facility |
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Helped to increase
the revenue of the company by 50-60% |
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