Case Study: Healthcare Payer achieves trustworthy, compliant high-volume EDI claims processing with Infogix Data Analysis Platform

Ensuring Trustworthy B2B Insurance Transmissions

A top-ten U.S. healthcare insurer processing more than 500,000 claims daily across multiple plan types faced increasing volume and complexity of EDI X12 transactions under HIPAA. The insurer struggled with transmission, operational and audit risks—file corruption, missing or duplicate data, delayed transactions and a paperless audit trail—while errors were often detected only after costly X12 translation, making manual correction impractical and threatening growth and compliance.

Infogix deployed its Enterprise Data Analysis Platform at key control points before and after EDI translation to automatically detect empty or partial files, unauthorized submitters, duplicates, out-of-sequence batches and segment issues, and to reject erroneous files. The solution delivered proactive issue identification, improved data ownership and tracking, reduced duplicate processing, met audit and submission timetables, and cut per-claim processing costs from $5–$15 to about $1—boosting efficiency, compliance and profitability.