Healthcare Provider and TPA

Our client is one of the largest medical groups in California. Their core claims processing platform is IDX, a legacy system now owned by General Electric. They also run a myriad of custom built systems and off-the-shelf systems that manage and connect the various pieces of their enterprise. In addition to their medical operations in which they deliver care through a network of over 400 employee and 1200 contract physicians in 40 offices, they have a substantial claims processing operation, processing over 400mm claims per year as a Third Party Administrator. The PatientKeeper application is one of their key clinical systems, and communication between it and their IDX claims platform, as well as other key applications, was becoming an increasing challenge.

 

Our client's systems entailed a good deal of custom .NET development

Pain

Our client needed to integrate the PatientKeeper patient feed into multiple internal processing and reporting systems. The existing infrastructure for doing the import did not meet the standards established by the management team: It was not flexible, and was expensive and time consuming to maintain. speakTECH was called in to address the needs with BizTalk Server. Our client needed a system that would not only replace their existing legacy code and manual processes, but would also provide them with a development platform that would position them well for future changes in data structures or client feeds.


Replaced Technology

Our client's systems entailed a good deal of custom .NET development from prior projects, plus a great deal of legacy code.


Replaced Processes

Like many healthcare organizations, our client suffered from the need to manage multiple systems that all processed files differently and with varying levels of processing capabilities. The majority of the work was done via manual processes with human checks to ensure accuracy, causing unnecessary expense and error rework.

Proposed Solution

Our proposed solution for these issues called for an implementation of BizTalk Server utilizing the Microsoft HL7 accelerated adapter. We would:

  1. Assist the EDI Group in the development of BizTalk based publish and subscribe architectural requirements.
  2. Assist the EDI Group in the research of BizTalk 2004 and 2006 solutions in support of our clients BizTalk architectural requirements.
  3. Assist the EDI Group in the definition and design of BizTalk 2004 artifacts in support of the BizTalk architecture.
  4. Assist the EDI Group resources implement BizTalk 2004 architectural artifact building blocks in a prototype environment.
  5. Assist the EDI Group in the planning, design, and implementation of the Patient Keeper interface which will utilize our clients publish and subscribe architecture and building blocks.

Software Used

  • Microsoft BizTalk Server 2004
  • Microsoft HL7 Accelerated Adapter
  • SQL Server 2000
  • Visual Studio .Net 2003

Services Provided

During a four week Proof-of-Concept, speakTECH developed a system that included customization of HL7 for non-standard HL7 vendor implementation. The new system integrates three internal/external applications with the PatientKeeper data files on a real-time basis. The next phases of the project call for integration of other key clinical systems to their core financial applications.


Results

By leveraging the power of BizTalk Server 2004, many of the issues faced by our client were addressed quickly and effectively. speakTECH successfully demonstrated a unified process for importing and transferring PatientKeeper data both to internal and external applications and reports.

 
Customer Size:
200 employees, 400 physicians


Country or Region:
United States


Industry:
Healthcare


Customer Profile:
One of the largest medical groups in California. Their core claims processing platform is IDX, a legacy system now owned by General Electric.


Software and Services in Microsoft Office System
Microsoft BizTalk Server 2004
Microsoft HL7 Accelerated Adapter
SQL Server 2000
Visual Studio .Net 2003