About the Client

The Client is a leading public trust that primarily offer health plans to Oklahoma Public Employees and their families.

The Health Plan was formed in 1992 by 15 Oklahoma counties, it is solely owned by 60+ entities currently, operated and controlled by its participating Entities

The Health Plan was formed primarily to offer lower cost health coverage to Oklahoma Public Employees and their families. This is a mandate in which the Client excels and continues to focus on.

Business Challenge

The Client originally used excel spreadsheets to store its vast enrollment information regarding the health care plans, due to this the entire enrollment process was slow.

The client was unable to follow the ANSI 834 EDI Enrollment Implementation Format since data was stored in excel spreadsheets and there was no means to electronically transfer this data between employers and health insurance carriers.

ANSI 834 EDI Enrollment Implementation Format is a standard format for electronically exchanging health plan enrollment data between employers and health insurance carriers.

The client engaged Silicus to help develop a web based portal that could store employee records, and facilitate 834 EDI data interchange.

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Silicus Solution

Silicus had to understand and analyze the client requirement to customize the implementation of 834 transactions and then integrate with core application of the client.

Silicus developed a web-based portal using Microsoft .NET for 834 transactions interface, so as to transfer the enrollment information from the sponsor of the insurance coverage, benefits, or policy to a payer and integrate with core application

The following types of data were provided in 834 transactions interface:

  • New employee enrollment
  • Changes in member’s enrollment
  • Reinstatement member’s enrollment
  • Disenrollment of members

Technologies Used

Language ASP.NET MVC4
Language

C#

Language ASP.NET MVC4
Platform

Microsoft.NET, Windows

Database SQL Server 2012
Database

SQL Server 2008

IDE
IDE

Visual Studio 2010

Client Benefits

Cost Saving

The 834 transactions interface has significantly reduced the volume of paper to be handled and re-keyed, resulted in immediate savings in administrative and personnel costs of maintaining hard copy records.

Data Accuracy

The system facilitated tamper proof data interchange between the employees and the recipients i.e the insurance companies, through 834 transactions interface. The data transfer happens with HIPAA 5010 standards for the electronic exchange of member enrollment information and ensures data accuracy.

Data Security

The 834 transactions interface ensures data security from external threats. Through secure gateway, the enrollment information of the patients is transferred and safely reaches to the insurance companies without any distortion or loss.

Increased Speed

The large volumes of enrollment data of the patients can be transferred through the interface from the source to a destination location in a matter of minutes, enabling faster response and greater satisfaction.

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