The Client is a leading cost containment solutions company, which provides health and human service programs, veterans’ health administration, and managed care plans to government and commercial healthcare organizations. Based in the USA, the Client caters to government-funded, commercial and private entities. The Client’s key requirement was to develop three applications, namely, Accounts Receivable (AR) System, MeSA (Medical Support Application), EMPR (Employer Database Application), and VADM (Veteran Administration). In addition, the following objectives of the AR System were identified:

• Process bills for wrong claims that are sent to insurance companies
• Process remittances for payments/denials received from insurance companies
• Match remittances with claims by applying series of business rules
• Search remittances and claims on various parameters
• Manually link remittances with claims

CHALLENGES

• Unavailability of local database
• Remote infrastructure management

SOLUTION

We developed the following applications:

• AR Management - This module consisted of several screens to search remittance and claim details, as well as, manually link a remittance with a claim
• Remittance Posting - This was an automated process that utilized a series of complex business rules to match remittances with claims
• File Feed - This module was responsible for loading claims and remittances data into database from flat files
• Re-platformed the AR system into Java/J2EE with DB2 Server as database and WebLogic as an application server. This maximized the long-term sustainability of the AR System.
• Ported data from mainframe to DB2 server (Data Migration)

KEY HIGHLIGHTS

• Quicker access to information pertaining to claims, remittances, and posting
• Reduced processing time to post remittances through batch posting
• Increased operational efficiencies and lowered errors