Client Background
The client is a diversified, multi-national FORTUNE® 50 major health insurance provider in US, providing various health insurance plans under Medicaid, Medicare and commercial line of business
Client Need
- Integration of Claim, Member, Provider, and Clinical data from each health plan to the corporate RTR structure
- The CMS Interoperability Mandate is a significant requirement on the RTR program, which got initiated on 07/01/2021
- The process needed to be appropriately designed and implemented without affecting other health plan timelines and had to meet the CMS mandate deadline
- Coordination was required among the individual teams to push the data to RTR in the specified format
Our Solution
- Developed multiple stored procedures to map the logic with the JSON fields and generated the JSON using .NET application
- Optimized the process to push JSON messages to downstream within the run window and implemented the logging mechanism for effective monitoring
- Designed Automic workflows to source the data every 15 minutes and push it to RTR via API/Kafka Topic
- Created an automated process to report JSON schema errors and to notify business teams via email
Tools & Technologies
Sybase, Greenplum, Oracle, Microsoft .NET, IBM Datastage, Kafka, Atomic
Key Benefits
- Successfully integrated the health plan data as per the business need and timeline
- Created reusable components to be reused across the streams (Claim, Member, Provider, and Clinical) and achieved the optimal performance in all the streams
- Implemented error reports for reconciliation and to notify the business immediately
- Built robust process for initial and synchronous hydration handling up to 200 million records optimally
- Data is available for downstream applications to fetch member and provider details via APIs and useful for functional migration and channel applications
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