Case Study: Health Insurance Payer achieves HIPAA 5010 compliance and real-time claims visibility with Infogix

Implementing End-to-End Process Analysis To Assure HIPAA 5010 Compliance

A large customer-owned health insurer—one of the top five in the U.S. with more than 13 million members and roughly 176 million claims processed annually—faced mounting operational and compliance risks during the industry-wide transition to HIPAA 5010. High-volume EDI transmissions, system migrations and legacy decommissions led to missing acknowledgements, invalid and duplicate claims, costly manual reconciliations, insufficient audit trails and regulatory fines.

Infogix deployed its Enterprise Data Analysis Platform across key processing handoffs to provide near-real-time controls, end-to-end tracking and detailed audit trails. The solution detected empty, incomplete and duplicate transmissions, monitored acknowledgements, and produced analytics on provider and partner performance. As a result the insurer reduced invalid/duplicate claims, met audit requirements (including NAIC‑MAR), cut time and cost to detect/resolve EDI issues, saved over 30% in internal audit costs, improved SLAs and increased profit margins for certain claim classes.