The client is one of the largest Medicaid managed care organizations in the US, focused on low-income and chronically ill patient segments. With a rapid increase in customer volume, the legacy batch processes were causing delays and issues in calculating premiums and risk. iPivot partnered with the client to develop HL7 interfaces to multiple Health Information Exchanges (HIEs), improving the accuracy and speed of data integration and improving accuracy and speed in premium and claims processing.

Challenges

• Batch data management processes were causing delays and issues with data accuracy.
• Problems in calculating risks and premiums based on bad or missing data.

Solutions

• Developed, implemented, and supported several real-time HL7 interfaces to multiple HIEs using Mirth.

Benefits

• Improved data currency and accuracy.
• Improved calculations for risks and premiums based on real-time data exchange.
• Ability to better model care and costs, leading to improved profitability.