Case Study: Nonprofit Healthcare Payer prevents PHI breaches and fines with Infogix

Detecting Dirty Data to Prevent PHI Breaches and Fines

A nonprofit healthcare payer serving over 700,000 members across multiple East Coast states and providing ASO services faced a cumbersome, manual claims-review process and a complex, distributed adjudication flow. With strict HIPAA requirements for protecting PHI, the organization was at risk of provider-data errors that could lead to PHI breaches, costly fines, and incorrect payments.

Infogix deployed its Enterprise Data Analysis Platform between the claims staging DB and adjudication system to perform automated validations (TAX ID, NPI, ZIP and address-level checks), reconcile data and flag exceptions in real time. The solution produced daily dashboards and analytic reports, identified thousands of data anomalies for cleanup, and significantly reduced PHI breaches and associated fines while ensuring claims are validated before payment.