Insurance Claims Processing Case Study

Challenge:

An insurance company was concerned about the efficiency and accuracy of their claims process. In the existing process, data entry operators would input data for a claim, and then manually determine correct billing. Pricing was often incorrect and had to be adjusted at a later stage in the claims process, decreasing efficiency. The client needed an intelligent front end for their legacy system. It had to combine a user interface for data entry with programming that applied business rules to the information and assigned pricing, ensuring accuracy. Finally, the newly priced claim information had to be transferred seamlessly into the legacy adjudication system.

Solution:

A server-based application was developed for the client that could be easily scaled as their operation and total claims grew in size. This application allowed data entry operators to key in information for the claim without having to know any processing details involved in its adjudication or repricing. The application then repriced the claim according to specific business rules and passed the data for the claim on to a legacy system for adjudication.

Key Technologies:

• Java Server pages running on Tomcat server
• Java Beans technology used for encapsulating and protecting vital business logic
• PL/SQL
• Oracle 8i database engine

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Online Healthcare Provider Search Case Study

Challenge:

The client wanted to create a user-friendly search engine for medical providers in their network which would be accessible to visitors of their website. The search engine would need to provide an easy interface for visitors to quickly find providers in their geographic area by medical specialty.

Data for the providers was being sent to the client from several databases in varying file layouts. These file layouts would need to be standardized before the provider data could be published to the web.

Solution:

LanPro's Software Service Group assisted the client in standardizing their provider database. SSG worked directly with client personnel to develop the standard provider data format, and also to create conversion processes for each of the databases that were sending provider data to the client.

Once the provider data had been standardized, our SSG group then created a data transfer and integration process that allowed administrators to upload these files to the remote application server and then transfer provider data from these files to the application's backend database systems.

A web-based front-end was developed for visitors to the client's website. This easy-to-navigate front-end allowed visitors to query the application's database for providers filtered on geographic region and medical specialty.

Key Technologies:

• Microsoft Active Server pages running on Microsoft IIS
• SQL Server 7 database engine