Case Study: EmblemHealth achieves faster enrollment processing with Prolifics

Prolifics Leverages IBM ESB to Make Enrollment and Claims Processing More Efficient for EmblemHealth

EmblemHealth, a major New York health insurer formed from the merger of GHI and HIP, faced significant challenges adapting to new demands from the Affordable Care Act. They needed to modernize their systems to handle a large influx of new enrollees by replacing a traditional file-based model with a centralized Enterprise Service Bus (ESB) for faster, more efficient customer onboarding and claims processing. They partnered with vendor Prolifics to leverage their expertise with IBM integration products.

Prolifics designed and deployed a modern Service Oriented Architecture (SOA) using IBM MQ, IBM Integration Bus, and DataPower. This solution streamlined enrollment and claims intake processes, integrating them with systems like ClaimsXten and Trizetto. The results were highly successful, with Prolifics' implementation reducing customer information wait times from up to 48 hours to as little as 15 minutes, creating significant efficiency gains and a future-ready, agile technology foundation for EmblemHealth.

EmblemHealth

Rich Asciutto

Senior IT Director