Client Background
The Client is a leading health payer based out of US. Client was using the legacy systems for on-exchange and off-exchange enrolments. Client wanted to modernize their existing systems to process applications from various channels including CMS, online sales, paper based, from agents and private exchanges.
Client Need
- Build an enrollment system to accept and validate large volumes of applications
- Assign an incoming enrollment application to existing members based on their availability and generate new member IDs
- Validate large volume of enrollment applications at the rate of 10k per hour during the open enrollment period
- Integrate with third party applications to generate policy fulfillment kits and improve the ID card generation rate to speed up the process
Our Solution
- Built a pre-enrollment orchestration process to identify incoming application type and removes duplicates from processing
- Implemented multithreading in Windows services to process large volumes of CMS applications
- Implemented a member match logic with 5 sets of rules and a logic to accommodate U65 and O65 data in member match and member ID generation
- Built a configurable business rule engine with 120+ member eligibility and application data validation rules from Federal, State and Payer sources
- Implemented asynchronous communication to increase the application performance
- Enhanced existing integrations with third-party systems (Silver pop, RR Donnelley, Fiserv, etc.) from a service call to FTP through IBM Content collector
Tools & Technologies
Microsoft.net entity framework, Angular JS, jquery, ASP.Net MVC4, Bootstrap, IBM DB2, Java, Microsoft SQL Server, SQL Server Integration Services
Key Benefits
- Improved the enrollment process and removed duplicate applications, thereby reducing the inventory by 2-5%
- Handled large volumes of applications without any issues and processed 10k applications in 1 min 30 sec
- Reduction in match exception inventory from 15% to 3%
- Reduced manual effort from 21 man-days to 4 man-days
- Configurable business rule engine helped in reducing overall rule exceptions from 14% to 4%
- Improved enrollment application processing speed from 6K to 18K in an hour
- Increased fulfillment kit generation rate by 15%
- Improved ID card generation rate from 80k per hour to 320k per hour
