Industry
Home care, Hospice and Healthcare Staffing Services
Technologies Used
Azure Integration Services
Azure Logic Apps
Azure Functions
Key Outcomes
Efficient provider claim processing
Huge infrastructure cost savings
Lesser maintenance cost
VNB Health implemented a B2B EDI solution using Azure Integration Services to enable efficient provider claim processing. The solution could process claims and state medicaid system using Azure Logic Apps, Integration Account and Azure Functions.
Customer Profile
The customer is a prominent healthcare insurance provider serving a vast population. With a rich history in the industry, they are committed to delivering comprehensive healthcare solutions and enhancing member experiences. The organization operates in a highly regulated environment, necessitating robust and compliant systems. Due to the sheer volume of transactions and complex nature of healthcare data, the customer handles a significant workload, demanding efficient and reliable IT operations.
Customer Situation
The customer handled 270/271 Healthcare Eligibility Benefit Inquiry transactions to verify patient healthcare eligibility, coverage, and benefits. The customer relied on custom API interfaces built on Microsoft BizTalk Server to connect with multiple insurance payers. This complex integration environment, characterized by high transaction volumes and frequent changes, was prone to instability. Updates to one payer’s interface often disrupted connections with others. To mitigate this risk, accelerate development and ease the build, deployment and testing process, the customer sought an automated solution that would enable continuous integration and continuous delivery (CI/CD) with robust automated testing.
Customer Profile
Customer's healthcare brand includes home care, hospice and healthcare staffing services. These services are provided by a network of more than 300 independently operated franchise locations throughout the United States that employ nurses, therapists, aides, companions and other healthcare professionals who provide 25 million hours of home care service to 190,000 people each year.
Customer Situation
Customer was using an old third party EDI software to process claims with state medicaid system. Adding new trading partners was becoming very expensive for the customer when using the legacy platform. Support and maintenance of the existing solution also incurred additional cost. Customer wanted to have an agile solution in place that is economical and scalable. They also wanted to move to a technology that is easy to learn, develop and maintain in-house.
VNB Solution
After conducting a detailed assessment of the client’s existing environment, VNB recommended an EDI solution built using Azure Integration Services platform. VNB leveraged Azure Integration Account to manage partners and agreements, Azure Logic Apps to manage workflows, Azure Functions to execute transformations and Azure on-premise data gateway to exchange data with on-premise systems. VNB utilized an agile approach, which included:
- Setup and configuration of trading partners and agreements using Azure Integration Account
- Development of complex maps to transform EDI 837 Claims and EDI 835 Payment Advice
- Download / Upload EDI files from trading partners to on premise systems using API connections and on-premise data gateway
- Tracking and monitoring business transactions using Azure Log Analytics
Customer Benefits
By leveraging Azure Integration Services' pay-as-you-go model, the customer saved 45% on the infrastructure cost.
Azure Integration Services provided easy-to-use, intuitive integration tools resulting in 30% lower maintenance cost for the customer.
