Case Study: Health Benefits Company achieves reduced claims processing time and costs with Infogix

Improving a Claims Validation Processes

A large multi-state health benefits company—one of the nation’s top five payers serving more than 13 million members—faced a complex HIPAA/EDI 837 claims environment in which a significant volume of claims were dropping between its Claims Editing and Claims Processing systems. The payer could not confirm 999 acknowledgements for every 837, forcing hours- to days-long manual investigations, delaying claim resolution and straining trading partner relationships.

The organization deployed the Infogix Enterprise Data Analysis Platform and implemented six automated checkpoints to reconcile 837s, proprietary ACKs and 999s and provide real-time, end-to-end visibility, alerts and role-based dashboards. The solution increased claims-processing efficiency and data reliability, improved trading partner relationships, enabled proactive error detection and drastically reduced the time required to locate and correct problems.