Take your enterprise to 5010 compliance with TransformEdge

Please click on the video below to learn more about the TransformEdge methodology and the technology that powers it..

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Channel Modernization & Technology Governance

The company, a large healthcare organization,had launched two concurrent enterprise wide programs – Back End Modernization and Channel Modernization. Object Edge delivered the architectural report for the channel modernization.

As a further step, Object Edge was invited to provide the detailed architecture for the EDI channel, which accounted for the bulk of the healthcare transactions. Following this architecture assignment, Object Edge was awarded the project to implement EDI across the enterprise, which included the following transactions:

  • Enrollment (834)
  • Claims (837)
  • Claims Status Enquiry (276/277)
  • Eligibility Enquiry (270/271)
  • Authorization (278)
  • Premium Payment (820)
  • Electronic Remittance Advice (835)

The transactions had to comply with the latest HIPAA mandates – the numbers above indicate the transaction identifiers in the HIPAA regulation. The project is still under execution and is expected to go live in August 2010.

Performance / Capacity Model for Healthcare Insurance Administration System

The customer had embarked on an extensive modernization exercise and as part of this exercise planned to implement an enterprise healthcare insurance administration system. The company was evaluating a well known administration system, which promised high levels of scalability and state-of-the-art technology platform with e-business integration.

Object Edge was retained to evaluate the system and advise if it could scale to meet the current and future business volumes. We had devised extensive bench mark tests to be conducted in a controlled environment to generate a high level of confidence in the assessment. However, the system was unavailable to conduct benchmark tests and we had to settle for data points provided by the vendor on past performance demonstrations.

We conducted high level business analyses of the batch streams and generated end-to-end process abstractions for the current state. We then mapped these process abstractions into the new system processes to arrive at the future state processes. We also conducted a detailed risk analysis.

We further conducted performance analysis (qualitative and quantitative) using the available data points. Qualitative analysis included an assessment of the architecture with respect to scalability, amenability of system to accommodate changes and surge loads and modularity of system to allow for effective partitioning and working as subsets. Quantitative Analysis involved creating an analytical model to understand the scalability of the system and providing some insights into capacity planning.



 
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