Case Study: Not-for-Profit Health Benefits Company achieves accurate 3Rs claims and membership reconciliation with Infogix

3R Data Integrity

This not-for-profit health benefits company serves more than three million members with HMO, PPO and Medicare plans and needed reliable, auditable reporting to meet ACA 3Rs requirements. Its challenge was the labor-intensive, manual coding required for CMS-driven validations and the critical need for accurate reconciliation and an audit-ready methodology to avoid rejected submissions, extra costs and rework.

The organization implemented the Infogix Enterprise Data Analysis Platform to automate business rules and validations (including ICD/CPT checks), perform summary balancing and reconciliation, and provide executive dashboards, real-time error reporting and analytics. As a result, irrelevant data is caught before loading, claims and membership records are reconciled throughout processing to ensure accurate Edge Server outputs, error discrepancies have fallen, and the plan is audit-ready and expanding the approach elsewhere.