Health Insurance

IT Outsourcing to Ukraine

The business goal was to design and implement a reliable and extensible turn-key solution for the healthcare industry providing the direct access to the eligibility benefit information in compliance with National Electronic Data Interchange standard (Health Care Eligibility Benefit Inquiry and Response ASC X12N 270/271).

The major challenge was to integrate the software with the existing clinical system (Millbrook Practice Manager) and the information source (Connecticut Medical Assistance Program) to syncronize information about patients and their eligibility data. To accomplish this goal a 3-tier architecture was designed with browser-based user interface (ASP.NET), server-side business logic layer (providing the major functionality for inquiry/response file processing, syncronization, etc) and rubust database back-end (with extensive use of stored procedures to ensure faster and more reliable database operations).

Scheduled syncronization with the clinical system and information source(s) is managed by the Windows Service. A direct database-to-database connection was implemented to process large amounts of imported data and avoid excessive workload on the clinical system.

Actual eligibility inquiries/responses are submitted/downloaded in the batch mode using either dial-up BBS connection or HTTP web interface to the information source(s). These submissions/downloads are available in two modes: scheduled and on-demand.

One of the most important business features of the product is the PDF-based reporting module which allows several report modes and formats and doesn't require additional report viewing software on the client side (except Acrobat Reader).

Implementation steps were completed in close collaboration with the Technet Solutions team to ensure that the solution matches the highest customer expectations. Beta version was deployed and fully tested on the pre-production server and moved to the production server after the customer's approval.

Further development plans include adding the support for other clinical systems and information sources, as well as Health Care Claim Payment/Advice support (ASC X12N 835).

Deployment

Server platform: Microsoft Windows Server with Internet Information Services web server, Microsoft SQL Server and Microsoft .NET Framework.

Client platforms: Microsoft Windows XP/Vista/7/8 with Microsoft Internet Explorer and Adobe Reader.

Benefits

  • Reduced operation costs by eliminating error-prone and time-consuming manual processes.
  • Improved overall business efficiency by implementing the new planning, reporting and analysis processes.
  • Enabled flexibility and scalability for the future system enhancements.

Customer: Technet Solutions (United States), a consulting firm providing outsourced IT services to healthcare organizations.