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Case Study: Rapid Application Development Cleansing Solution for a $4 Billion Healthcare Firm

A large healthcare provider needed a data cleansing solution to improve cash flow.
  
 

The Partner
 This project was based on our partnership with a top-five global consulting firm.

      
 


The Client
The client was a large healthcare provider conglomerate with revenues over $4 billion.

      


The Challenge
The client's healthcare operation had an automated process to send data to insurance carriers for reimbursement of medical expenses. While the system had been in place for several years, its success was poor. Claims were continually sent to the insurance carriers, only to find months later that the data was inadequate and the claims were rejected. As a result of problems in the claim data, the client had to wait to be reimbursed by the insurance carriers, sometimes for many months.

The client planned a new solution, but it was expected to take over a year to implement. In the meantime they had a significant cash flow problem from the rejected claims and needed a temporary solution that could help until the permanent solution was implemented. Since the solution was expected to be temporary, the client needed an inexpensive approach that could be implemented immediately.

Our consulting firm partner brought us in to see if we could assist.
 
 


The Approach
The solution was based on Applaud's "rapid application development" data quality capabilities.

We began by using Applaud's quality audit features to extract, profile and analyze data from the client's system. The client used the facts learned during the profiling and analysis to establish rules for the validation and specifications for the reports that would identify the problems. We then used Applaud's rapid application development tools to build the solution.

The solution is now imbedded in the client's daily batch processing. It identifies any claims that do not include all necessary data and holds those claims in "suspense" until the required information is added. It produces comprehensive report identifying all of the problems so it is easy for the client staff to correct the data. When all needed data is provided, it sends the claims on to the appropriate insurance carrier. 		     
       
 

The Success
The project was a huge success. The client was amazed at the short time of the effort and the large value we added. The client's quote: "Applaud enabled us to deploy a comprehensive cleansing/reporting subsystem in less than two months . . . Our Applaud solution continues to help us improve our facilities' intake, thereby resulting in increased cash collections in a timely manner."

     
       
 

Why We Can't Mention the Names of Our
Partners and Clients

In this project we partnered with a global consulting firm and are contractually restricted from disclosing the names of the partner and the client. We will be pleased to provide references on request.

Learn more about our Partners and Clients...
     

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