USA
Belgium
France
UK
Australia
India
Singapore
Client Background
The client is a managed care organization operating in the US.
Client Need
- Helped in setting up a data warehouse for combined entity and report generation.
- Set up cloud environments and servers with best practices.
- The client does not have a robust reporting module for their Medicaid and Alliance lines of business.
- Their business is handled by multiple vendors in bits and pieces which hinders the reporting capabilities and data integrations.
- They needed to migrate data from multiple vendors and create a data warehouse for reporting
- Needed to move from the existing Azure cloud to SoftLayer.
- To create multiple environments and set up multiple servers in the cloud.
- To create HEDIS reports for state Medicaid.
- As the client merged with another leading health plan provider, they needed to maintain the same vendor database for both the entities which required mapping of data from existing SQL DB to the new proposed Oracle DB.
Our Solution
- Migrated client systems from Azure to SoftLayer.
- Built reporting capabilities using Tableau for various reports including HEDIS reporting.
- Used ETL jobs to dump data into the data warehouse by converting the data extracts from different vendors.
- Designed a single source data warehouse system using SQL to process member and claims information for generating reports.
- Developed reports using extracts received from Optum DB for pregnancy-related claims and dental vendors for enrollment and claims.
- Mapped existing database with medical vendors’ new database and identified multiple gaps in the new DB.
- Mapped the data elements between two different data sources for acquired health plans with current health plans.
Tools & Technologies
Microsoft SQL Server, Microsoft SSRS, Tableau
Key Benefits
- A centralized data warehouse enabled a single source for reporting.
- The in-house reporting system helped in meeting deadlines for the submission of mandatory reports to the State system.
- Sped up the encounter submissions to State, and consequently increased the acceptance rate.
- Created customizable reports to be scheduled and fetched on-demand.
- Made the reconciliation process easy by tracking all encounter submissions and responses from State.
- Readily consumable reports on claims and enrollment business at each lower granular level.
- Improved process efficiency and accuracy and reduced manual effort while adhering to regulatory compliance.
