Custom Software Solutions for Insurance
THE CLIENT:
While you may have never realized it, health insurance firms are really software companies. They use software to provide an avenue for people to get the care they need. They leverage this technology to help clients set up and pay for services. Our client is the intersection of many health insurance firms giving access to a range of insurance products.
THE BUSINESS NEED:
Our client needs to process large amounts of data due to the high number of insurance payers connected to them. Unfortunately, there is no industry standard for this data. So, our client spends a great deal of time and money converting the data from the different payers into information they can use. They wanted a system that would simplify this process.
WHAT GENECA DID:
Geneca created a system that allows our client to:
- Accept data from any source in any format
- Process it for internal use
- Provide that data to other companies in any form they require
Basically, our client becomes the data middleware. To do this, we created an environment that allowed for dynamic data definition, data acceptance process and validation, data storage, and output and transmissions.
Data Definition
An Entity- Attribute-Value (EAV) model is a common technique in the software industry, but it is often used inappropriately or built poorly. We effectively used this model to give our client the ability to define any data they need to store. They can also give the data rules for acceptance, and the data can be given to engines to be manipulated or validated. The data can be converted into something more standard, stored exactly as received, or anything in between.
Data Acceptance and Validation
The acceptance rules are given in the form of regular expressions and dynamic query creation. In addition, engines may be created and added to the system at any time to do more data processing, including comparisons to current and past data, API calls, database lookups, etc. A robust import definition was created to allow the designer to test and play with the data in real-time to fashion the result they are looking to achieve.
Data Storage
The data itself is stored in this EAV model, allowing for infinite configuration. All native data types are possible, but we can also create new data types with new rules that define how they function. We store a complete history of changes to any data and provide a “Time Machine” that allows any data from the past to be used when reporting or exporting. Our client doesn’t need to store the old versions since we can recreate them at any time.
Another feature of our EAV designs is that we allow for “overriding” of data. Using this feature, a user, team, or department can change data but only apply it to themselves. This allows them to play different what-if scenarios and simulate different situations without affecting anyone else.
Output and Transmissions
We can output data and reports in a similar manner to how we accept data. We created a “Query Builder” to give access to all data, even for a novice user. Like the import process, we can build engines to create special processes around data that can be used on any element. We can then send that data through various transmission modes as selected.
THE RESULTS:
Our client is still implementing changes to the way they want the data to process; however, because of the new data system’s ability to output data in any form, the existing systems can accept data from it. We simply mimic each system’s old data feed and provide it through the new data system.
In addition to the acceptance and output of data to applications outside their enterprise, the data system also works as a middleware layer that allows systems built or brought in-house to work together without change.
ABOUT GENECA
Geneca is a custom software consulting company with 20+ years of experience using advanced strategies to help clients stay ahead of their competition. At Geneca, we know that software isn’t one size fits all. We explore your unique needs and identify the right solution to accomplish your goals. We create lasting, solid partnerships with our clients and work together to design revolutionary products that engage users, transform industries, and evolve with your business.