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Case Study

Integrated the health plan data as per the business need of a diversified, multi-national FORTUNE® 50 major health insurance provider in US

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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