Electronic Remittance Advice (ERA) service provides claim payment information in the HIPAA mandated format by shortening the reimbursement cycle and streamlining the workflow.

The client is the single largest financial and administrative healthcare network in the United States, reaching approximately 750,000 physicians, 105,000 dentists, 60,000 pharmacies, 5,000 hospitals, 600 vendors, 450 laboratories, and 1,200 government and commercial payers. The client has developed this network of payers and providers over 30 years in the industry, connecting virtually all private and government payers, claim to submit providers and pharmacies in a hybrid cloud-based, user-centric, and secure infrastructure environment. In 2013, the organization was included as part of the Information Week 500 list of Top Technology Innovators in the United States.

Customer Need

The client wanted to Retire JCAPS and improve performance, reduce cost and velocity. They were also looking for a futuristic model that would ease their workloads.

The client also wanted a reusable framework for migrating applications like transaction data repository (TDR) to AWS​.

Processes were inefficient, productivity was low, and costs were high.

Solutions Provided

To ease the workloads, Innova leveraged cloud expertise and renovated the following:

    • Replaced JCAPS​
    • Redesigned the applications to run independent of JCAPS services such as web services, validations, transformation, streaming, and others​
    • Replaced Oracle DB to AWS MySQL RDS​​
    • Migrated cXML file storage from Oracle DB to S3​​
    • Redesigned the code to use S3 for cXML file storage instead of Oracle database​
    • Replaced MySQL RDS in place of Oracle DB for storing the   persistent storage of transaction data​
    • Introduced pipelined processing​​-SNS based file S3 file activity monitoring and processing using lambda​​
    • Integrated​ Redshift and TDR​
    • Integrated the application with the universal datastore for all transaction data across the enterprise using Kinesis framework​

Benefits / Results

  • Saved licensing and support costs over $10M
  • Enterprise-wide universal datastore and data warehousing for all ERA transactions
  • HIPAA compliance of the overall environment
  • Fully orchestrated resource provisioning and configuration
  • Reduction of servers in favor of AWS managed services wherever possible

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