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  Global medical insurance services

Custom Project Name

Global medical insurance services

Customer (country)

A leading provider of claim management system (USA)

Business Case

State regulations and business processes in health care and insurance industries constantly change, so modern applications have to be flexible, customizable, and should provide workflow management rather than simply reflect the fixed state of business.

Facing increased competition in the insurance industry, our customer - provider of best-in-class claims managements systems, needed to develop a highly scalable business application that feature extraordinary level of customization including a possibility for a company to design and support its own workflow processes. It should provide tools to track insurance information, claims, provider and patient information, medical, regulatory and legal guidelines, and much more.

Solution

Novosoft developed a data-centric solution, providing a possibility to enter same data into a variety of industry-standardized forms to accommodate differing needs of various jobs. It uses a three-tier architecture and contains business logic in its middle tier. The application supports several different back-end databases and includes the option to use native Visual FoxPro data. It also tracks all data changes and provides a complete "audit trail" of activity.

The system interfaces with several Microsoft Office applications and uses a number of ActiveX controls, including several designed by Novosoft specifically for this project. Novosoft also developed an Internet front-end to facilitate the data entry of preliminary Claim Notices. Another unique module developed by Novosoft for the project is a suite of Analytical reports accessible through the Web. These reports allow customers to review services online and to analyze the services provided, as well as to view current claim status, statistics, etc.

Tools and Technologies

Development tools for Client-Server part:
Microsoft Visual Studio 6.0 (VFP, VB, VSS), Crystal Reports
Development tools for Web part:
Microsoft VS.NET, Crystal Reports
Modeling tools:
Rational Rose, ER-Win
Management tools:
Microsoft Project, Quality Assurance Journal*,
Change Management Database*,
Project Management System*
Database servers:
MS SQL Server 7.0, 2000, Oracle server 8.1

* - Novosoft internal Lotus Notes based systems

Benefits

The customer received a first class product at a very reasonable price. The system has attracted a flow of new clients, increasing customer's position in the market and providing increased satisfaction and new-customer acquisition.

As a result, the solution developed by Novosoft generates the maximum return on technology investment by:

Integrating claims, care and medical cost management teams to improve loss outcomes and costs
Enabling organization specific work-flow design and automation to increase labor efficiency
Reducing technology costs by blending client server and Internet data management strategies
Reference

Available upon personal request



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