case study

Multibillion-Dollar Health Plan Provider

Driving Digital Transformation for a Complex Healthcare Enterprise

Multibillion-Dollar Health Plan Provider

One of North America’s largest health plan providers needed expert solutions to complex digital problems.

In a long-term engagement with Object Edge, they looked to modernize and restructure their company to set it on track for digital maturity.

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Our healthcare experience includes two major payers and a national network of hospitals.

Our Business Analysts and Business Architects brought a deep understanding of the healthcare payer and provider issues. Technology Architects have solved architecture and design issues for the healthcare domain by using industry patterns with customizations.

For these complex enterprise organizations, our experience includes:

  • Business Architecture and Technology Architecture for e-business channels
  • End to end delivery of enterprise-wide EDI channel, HIPAA compliant
    • Enrollment
    • Claims
    • Eligibility Request-Response
    • Claims Status Request-Response
    • Authorization
    • Remittance Advice
    • Premium Payment
  • Enterprise Resource Planning (ERP) integration
  • e-Prescription Technology Architecture
  • Integration architecture for national network of hospitals
  • Enterprise Architecture IT governance model
  • Support for architecture, design and development of ESB
  • All aligned with HIPAA compliance
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The challenges included:

  • High maintenance cost with the existing, inflexible architecture/design
  • Lack of traceability for messages processed by platform
  • Systems not extensible to accommodate new mandates
  • Need to revamp backend system, depending on rebuilding and creating a strong EDI foundation
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Object Edge Expertise

• Deep understanding of the challenges and technologies for modern, digital, healthcare services, including:

• Built tools and accelerators, designed for the healthcare space, to deliver quality solutions on an accelerated schedule

• Best shore mix: on-shore expert business analysts and technology leaders to ensure shoulder-to-shoulder partnership with our clients, plus near-shore and off-shore support teams to provide value for maintenance of the healthcare solutions

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