Case Study: USAble Life

Sunday, December 13, 2015 - 20:45

Overview

USAble Life is a life insurance subsidiary dedicated to delivering protection and peace of mind to each of their customers, whether a consumer, employer group, or producer. With experience, financial stability, and high-quality products including life, accident, and health insurance sold at the worksite, they are committed to all of their customers’ needs. USAble Life takes great pride in making sure customers get the answers they need at the time they need them most through comprehensive policy benefits and prompt claims payment. USAble Life is partnered with many Blue Cross Blue Shield carriers providing enrollment, adjustment, reinstatement, and cancellation of policies through government-mandated file standards.

Challenge

The Health Insurance Portability and Accountability Act (HIPAA) requires all health plan or health insurance carriers to accept a standard enrollment format, the ANSI 834A EDI Enrollment Implementation Format Version 5010. The 834 EDI is the standard format for electronically exchanging health plan enrollment data between employers - the sponsor of the insurance coverage, benefits, or policy - and health insurance carriers. USAble Life needed to develop, in a relatively quick timeframe, ETL processes to generate the ANSI 834 EDI Enrollment Implementation Format for the Blue Cross Blue Shield of Massachusetts (BCBSMA) carrier, and do it in such a way that the solution could be extended across all Blue Cross Blue Shield partners. In addition, USAble Life required a generic file creation process to be built to support other divisions within partnered companies, such as payroll departments. The requirements for the generic file’s format were to stem from universally sourced file layout definitions written in XML.

Approach

USAble Life enlisted the services of Inquidia Consulting to recommend and execute a big data integration solution. Inquidia leveraged Pentaho Data Integration (PDI) to source standard extract files, loop through insurance groups, subscribers, members, & primary care physicians in order to provide a holistic view to partners in the aforementioned government standard 834 file format. Inquidia also developed a generic file creation process which injects metadata from a very flexible XML file source and produces an ETL that can build different flat files per the XML definition received.

Results

USAble Life now has the capability to generate and deliver the 834 EDI files not only to the BCBSMA carrier, but to future partners as well. This is possible through the flexible ETL processes built to produce a file per a short list of properties that can be toggled for each Blue Cross partner’s requirements. USAble Life also now has the ability to generate additional files through the Generic File Creation process for not only their internal departments but also their partners. These files can serve customized files to virtually all areas of the business because of the superiorly flexible XML file definition method employed.

Contact us today to find out how Inquidia can show you how to collect, integrate and enrich your data. We do data. You can, too.

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