THE CLIENT:
Every time you get a health procedure or medication covered through your insurance provider, there’s a company and software application behind the pre-approval process. Our client is one of those companies.
THE BUSINESS NEED:
Our client was expanding their business to include more analytics that would ultimately help their clients understand how services are used and drugs are prescribed. However, the platform and application our client originally built in-house for utilization management wasn’t efficient enough to allow for growth.
Our client’s team was spending too much time working on pre-approvals. As a result, they couldn’t devote enough resources to their new analytics processes, which they believed would set them apart in the industry.
A third-party vendor with highly customizable off-the-shelf software was brought in to take over the pre-approval processes, but our client needed a way to translate the data they received from providers into an acceptable format for the vendor.
Our main objectives for this project were to:
- Coordinate communication between all parties
- Extract current data
- Translate current data into an acceptable format
- Send translated data to third-party vendor
WHAT GENECA DID:
Our team of business analysts and developers took all the data from our client’s homegrown system, extracted it, transformed it, and inserted it into the new third-party system. Data from providers in the payer’s network, membership data, eligibility data, reference data, and more were translated and migrated.
Our client and their third-party vendor each had their own preferences and rules in place for their systems, which meant the data from the two systems weren’t compatible.
To fix this issue, our team became translators. Just as you would translate French to English or German to Spanish, our Genecians translated our client’s data into the “language” of their vendor.
THE RESULTS:
Data is still being translated and migrated, but our team is on track to finish within the project timeframe. Our team continues to coordinate communication between ourselves, our client, their clients (insurance providers), and their vendor, ensuring all milestones and goals are met as we near the finish line.
With the data migration complete, our client will be able to focus on their game-changer: analytics. Their team can say goodbye to wasting time and energy in a system they had outgrown and can throw their talent into what matters most to their business’s success.