Insurance Claims Process Streamlined with Custom Application


The Client

Health Management Systems (HMS) provides cost containment solutions for federal and state government, commercial insurers, and other organizations. The company ensures healthcare claims are paid correctly and by the responsible party, and that those enrolled to receive benefits qualify./

The Challenge

HMS’ existing Accounts Recovery (AR) Matching System was unable to handle the growing work load of addressing monetary claims recovery from the correct insurance carriers. They wanted to dramatically improve claims processing time, which took up to 24 hours for larger clients, while increasing percentage/recovery rate for account reconciliation.

The Solution

HMS called upon IBS to take a look at the existing AR Matching System to review, analyze, reengineer, design, develop, and implement a new state-of-the-art version. They upgraded and transformed a 30-year-old automated claims billing technology into a new system that efficiently accommodates client demands. A successful implementation meant the new system that could process one million remittances each week for over 40 states, the Veteran’s Administration, and commercial accounts. A complete, unique AR system was necessary for each of their over 55 clients.

The Results

IBS provided HMS with a robust, intuitive and complex AR Matching System with a multi-functional application that satisfies the complex needs of multiple AR clients. Processing time was significantly decreased, cutting larger clients’ 24 hour process down to 2 hours.

Subsequent improvements now provide a much better way to sync information from various databases. IBS’ offshore team continues to expedite the migration of old AR clients and address the current pressures created by increases in volume and demand as new clients come on board.

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Technologies

Technologies used:



  • Java J2EE
  • DB2
  • Informatica
  • SQL