Case Study: Health Benefits Company achieves complete claims adjudication and real-time visibility with Infogix

Ensuring Complete Claims Adjudication

A large, multi-state health benefits company—one of the top five U.S. healthcare organizations serving more than 13 million members—was struggling with a fragmented, four-part claims adjudication process spanning mainframe and distributed systems. Thousands of claims went missing daily (once more than 100,000 were untraceable), manual reconciliation was time-consuming and risky for PHI/HIPAA compliance, and an external audit flagged control deficiencies.

The company deployed the Infogix Enterprise Data Analysis Platform to provide end-to-end, real-time and batch validation, timestamp tracking, balancing and reconciliation across all processing steps. The platform delivered immediate visibility into claim locations, daily suspense and aging reports, a full audit trail to support SLAs and compliance, and eliminated the manual “guessing game” that had blocked timely adjudication.