Provider
Home care, Hospice and Healthcare Staffing Services
Technology
Azure Integration Services, Integration Account
Azure Functions, Logic Apps, Log Analytics
Azure On-Premises Data Gateway
Key Outcomes
Reduced infrastructure costs by 45%
Ongoing maintenance costs dropped by 30%
Improved efficiency with greater flexibility
VNB Health helped the provider streamline claims processing by implementing a modern, automated system. The solution improved efficiency, reduced processing delays, and ensured seamless claim submissions to the state Medicaid system. By eliminating costly inefficiencies, the customer was able to manage claims more effectively while reducing operational expenses.
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
The customer is a leading healthcare provider offering home care, hospice, and healthcare staffing services. With a network of over 300 independently operated franchise locations across the United States, they employ nurses, therapists, aides, and companions who deliver 25 million hours of home care services to 190,000 people annually.
Customer Situation
The healthcare provider relied on an outdated third-party system to process claims with the state Medicaid system. This legacy platform was becoming increasingly expensive, especially when adding new trading partners. Furthermore, the cost of support and maintenance continued to rise, making it difficult to manage operations efficiently. Additionally, the system was complex and required specialized expertise, which limited the customer’s ability to make updates or improvements in-house. As a result, they needed a modern, cost-effective solution that would streamline claims processing, reduce dependency on external vendors, and allow for seamless scalability.
VNB Solution
VNB Health worked closely with the provider to assess their existing setup and identify key areas for improvement. Our team developed a tailored solution that simplified the claims processing workflow, making it more efficient and cost-effective. Rather than relying on the outdated system, the customer transitioned to a structured and automated medical claims processing system. This shift improved their ability to manage new trading partners, minimized operational bottlenecks, and provided better visibility into transactions. In addition, the new solution introduced a user-friendly approach, allowing their internal team to maintain and oversee the system with ease.
To facilitate a smooth transition, VNB Health established a standardized framework for managing healthcare claims and payment processing. The solution also automated claims submission, tracking, and reconciliation of Medicaid claims, which reduced manual intervention and minimized errors. Moreover, real-time claims monitoring capabilities enhanced oversight, helping the customer proactively detect and resolve issues. As a result, claims accuracy improved significantly, and claims processing time was greatly reduced.
Customer Benefits
- Significant Cost Savings: The customer reduced infrastructure costs by 45% by transitioning to a more flexible, usage-based model.
- Lower Maintenance Effort: With an intuitive and easy-to-manage system, ongoing maintenance costs dropped by 30%, allowing their team to focus on core operations instead of troubleshooting technical issues.
- Improved Efficiency: The streamlined claims processing system reduced delays and administrative overhead, resulting in faster reimbursements and improved cash flow.
- Greater Flexibility: The new system provided a scalable foundation, allowing the customer to onboard new trading partners quickly without incurring high costs or complex setup requirements.