The Client
A payer in healthcare segment with operations spread across 13 states in the USA. The client handles more than 100,000 claims, 400,000 members, and 50,000 providers on a per day basis.
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Objectives
The underlying strategic objective was to re-architect and reengineer existing Medicaid Management Information System (MMIS) and pharmacy POS system into SOA-based real time claim adjudication system with single sign on and RBAC implemented among applications integrated. The aim of the project was to have interoperability among all major functional components / applications and integrate all into a single enterprise platform / framework. Some of the key objectives are:
- Integrate the various systems involving claims system, enrollment / eligibility, provider / trading partner management, pharmacy Point-of-Sale (POS), workflow processes, EDI processes, contact management, Interactive Voice Response (IVR) into a single enterprise platform
- Implement a common security services framework for the system based on LDAP. All the application authentication / authorization will be done against the LDAP
- All application components to be incorporated with RBAC and SSO
- Position client as a pioneer Medicaid IT solutions provider who is committed to implement systems based on latest technologies
- Integrate the system which has the flexibility of externalizing the entire business rules associated with it
Wipro’s Scope of Work
Wipro is currently working on the end-to-end application development life cycle with requirements, design, construct and test. The solution involved is about building services to facilitate real time adjudication and easy and faster access to data. The major operations carried out are:
- Build a system based on the SOA and enterprise service bus design concepts with loose coupling among different layers of the application
- Requirements elicitation and use case modeling
- Detailed application architectural design for each iteration with architecture documents
- High level and low level application framework design
- Customized business object model for business rules
- Integration with Commercial off the Shelf (COTS) products
- Common event logging, notification, messaging, audit logging
- Application development policies and procedures (configuration management, issue resolution / tracking, build / deployment, project communication)
- Program governance
- Unit / integration / system test cases, scripts and reports, deployment of scripts / guides / user manual
Engagement Complexity
- Building a core product keeping in mind the future state-specific platform (COTS) considerations
- Complex design structures with integration to more than 40-50 COTS products and lot of external interfaces
- Maintenance of Medicaid and PBM legacy / client-server based applications painstaking for the IT staff
- Implementing a truly SOA-based system, a truly customizable core product with key security mechanisms in place
Technology
- IBM Tivoli Access Manager / Tivoli Identity Manager used for security mechanisms
- FairIssac Blaze advisor - Rules management
- J2EE, IBM WebSphere Process Server, IBM Application Server, RSA, RAD, Hibernate - Application Development
- RequistePro, Rational ClearCase - Requirements management
- Silk Suite - Application testing
Benefits
- Provided a 24x7 real time enterprise application with entire claims adjudication / enrollment / eligibility process integrated. Reduced administrative and training costs
- The system built on open standards which are highly configurable based on state to state requirements
- Highly scalable and easy maintenance of the application with single sign on facility
- Cost effective hardware / software platforms and customer self service functionalities to reduce system operational costs
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