Customer Success: Health Care Payers
Business Benefits
Relativity Technologies has helped health care payers to increase the efficiency and flexibility of their enterprise applications.
Health care payers depend on their application portfolios to govern and execute their daily business activities. Claims processing, account management, and other central systems are built on highly complex and often inflexible systems. As competitive pressures continue to mount, health care payer companies must be able to adapt through Enterprise Application Modernization to support emerging business strategies.
Relativity Technologies can help. The world's leading insurance providers have relied on the Modernization Workbench® platform to realign their enterprise application portfolios with business needs.
Leveraging the Business Value of Enterprise Applications
FEP, Administered by CareFirst Blue Cross Blue Shield
Business logic uncovered, componentized, and redeployed in a web-enabled application. Upgrade of database executed with no impact to the stability of the application
To build on its reputation for outstanding customer service, this leading U.S.-based healthcare payer decided to improve response times for its customers by streamlining its back-end claims processing systems and web-enabling customer support. Operating on 20-year old legacy applications, the payer's claims system had been substantially modified and enlarged, adding to its complexity and causing it to exceed several million lines of code. To rebuild the claims system from the ground up would take 6 to 7 years according to early estimates by the payer. Instead, the project team opted to deploy an Enterprise Application Modernization approach for its claims applications.
To begin the initiative, the Modernization Workbench was used to better understand the complex application code. Analysis tools of the Modernization Workbench generated documentation and graphical representations of the various programs, allowing professionals to identify the sections needed to be preserved, restructured, or eliminated. With the analysis of the system complete, Relativity Technologies' consulting partners used the Modernization Workbench to uncover the system's business rules buried throughout the application. Doing so allowed the payer to reuse and simplify processes -- leveraging the existing investment made in their applications.
The combination of Relativity Technologies and our consulting partner, Capgemini (now part of Accenture's Health and Life Sciences practice), has helped to unlock the critical assets contained in the payer's legacy applications and to convert those assets into flexible, standalone, and Internet-ready components. Further, by componentizing the business logic spread throughout the program and modernizing the overall architecture, the claims system is simpler to maintain and easier to adapt to changes in industry conditions.
The bottom line: with help from Relativity Technologies, our client stays ahead of the pack in an increasingly competitive and cost-conscious world. Now, the Web-enablement and modernization gives FEP's customers, health care providers, and claims processors real-time access to claims information.
Enterprise Application Modernization "allows companies to embrace the Web and other emerging opportunities while increasing their ability to respond to shifts in strategy. And through our partnership with Relativity Technologies, we can provide these advantages more efficiently by using the powerful Modernization Workbench," said Ron Bissetta, principal with Capgemini.
Boost Claims Processing Efficiency with Application Modernization
Major Health Care Payer
Business rule management accelerates claims analysis by 70%
A key to profitability for any insurer is the ability to reduce the cost of claims processing. Each delay in completing a claim not only impacts customer service; it can also result in greater expenses, as more resources must be consumed to clear the backlog. When claims were entered into the processing system of a leading insurer, it was scrutinized for errors by a sophisticated enterprise application. The application was programmed with business rules that identified problem areas within the claim.
However, the rules were configured to send a claim for review after the first error was identified, without recognizing additional errors. This meant that a claim would often be reprocessed multiple times before it finally completed the process error-free -- a costly and time-consuming proposition.
To address these delays, the payer and a consulting partner utilized the Modernization Workbench platform to assess the claims application at the insurer's processing center. Using the platform, developers were able to rapidly uncover the business logic associated with the application using deep search functions and impact analysis.
By collecting and managing this logic, subject matter experts were able to accurately understand the structure and function of the application and its business processes. Doing so allowed the service professionals to target the correct rules to be modified within the application. With the execution of this project, the payer has been able to reduce the number of times a claim must be reprocessed -- an important step towards faster turn-around in the claims processing system. In fact, root cause determination for pending claims has been reduced by 70% as a result of this Modernization Workbench-led initiative.
