Workplace health care provider benefits from Modis’ HIPAA expertise

Client Overview: International provider of health care, related benefits

This Fortune 500 Company provides health care and related benefits offered through the workplace. Key product lines include health care products and services (medical, pharmacy, behavioral health, clinical information management, dental and vision benefits, and case and disease management); and group disability, life and accident insurance. In addition, the company also provides life, accident, health and expatriate employee benefits insurance coverage in selected international markets, primarily in Asia and Europe.

The Modis Solution: HIPAA expertise combined with testing and analytical knowledge

The client wanted their members to be able to access certain transactions over the Internet, while maintaining HIPAA compliance. The client initiated a project to allow their members to review eligibility and benefit information, as well as claims through a clearing house using the Internet. The client developed a Java-based application where each transaction from their providers is provided via a clearing house and is received in X12 format. This data is converted to “common record format” and sent to the mainframes. The request is processed and the relevant data is sent back to the clearing house in X12 format.

Modis provided business analyst resources to assist with the development of the business system design and testing for the 270/271 and 276/277 HIPAA transactions. The client has multiple eligibility and claim systems and applications were written for each of these back end systems. These applications included mapping of the source system data to “common record format.” Modis consultants worked on building the test plan strategy, test scenarios and test data. We also served as part of the testing team, coordinating the testing with the developers and business users. Technologies included Test Director and Winrunner testing tools to automate the testing process. Finally, Modis coordinated with the business users to resolve issues and meet the project deadlines.

Why Modis? Simply put, Modis was able to provide resources that had the right blend of HIPAA, testing and BA background that the client was looking for.

To see what Modis can do for you, contact your local Modis office today or read more healthcare & pharmaceutical case studies.