About the Client

The client is a group health insurance administrator appointed by a public trust to manage a health insurance plan for over 70 local government employers in a particular state of the United States. The participating local government bodies pool together to offer an affordable health plan for the participating counties’ local government entities, their employees and families.

Business Challenge

The current system for employee enrollment and management of records posed operational challenges and imposed limitations for the client to efficiently grow their health plans’ user base. The prior process used paper forms submitted by employees which needed to manually be entered by staff. The manual data entry was put into a Microsoft Access database which lacked an interface to track and manage records of health plan members.

The client wanted to develop a cloud-based application in a phased manner to manage internal paper and electronic health plan administration operations. Their objective for the first phase was to deliver a web-based, health plan enrollment experience for members.

Local government bodies have a large user demographic of non-English speakers who would greatly benefit from being able to enroll and manage their health plan in their native language. The client wanted the application to additionally support Spanish to increase their customer reach.

 

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Silicus Solution

Silicus worked with the client’s requirements to design and build a web-based application for health plan enrollment and administration. The solution also has features for internal reporting and an information resource tool for user education. The solution is multi-lingual and compliant with prevalent security and privacy standards.

The key features of the web application delivered to the client are as follows:

  • Online Patient Enrollment – Employees can register online through the patient portal. During enrollment, the portal captures personal information and preferences for the insurance plan, like beneficiaries, dependents, etc.
  • Online Authorization – The health plan employer’s representative are able to review and approve/disapprove the employee enrollments
  • Language Options – The option for using Spanish as the preferred language
  • Reporting module – Employer representatives can access reports to view listing of employees currently within the enrollment process, and also verify completed enrollments and produce reports of coverage selections.
  • Integrating training videos – Online videos are viewable in the portal to educate patients about the offered health plans
  • HIPAA-Compliant - Features such as audit logging, patient data privacy, and authorization features are integrated in the system.

The software was designed and implemented by Silicus’ development team with a scalable architecture to support the client’s future objectives. The client plans for further enhancements in the second phase including integration with partners and advanced reporting tools. Future development plans also include a tool for members to calculate and compare benefits across different health plan offerings.

 

Technologies Used

Language ASP.NET MVC4
Language

ASP .NET, C#

Language ASP.NET MVC4
Platform

Microsoft .NET

IDE
IDE

Visual Studio 2010

Language ASP.NET MVC4
Database

SQL Server 2008 R2

Client Benefits

Process Automation for User Accessibility and Internal Efficiency

The transformation from a manual, paper-based enrollment system to an online one was the primary benefit to both users and administrators of the health plan as it greatly reduces the time and effort spent on enrolling new members. The system improves accessibility with a user-friendly online interface. Automating the review and authorization processes leads to significant time savings and improves the availability, reliability and efficiency of the entire user enrollment management process.

Improved Customer Reach and User Experience

With the language flexibility option offered by the new application, the client can now expand its customer base to a Spanish-speaking audience in the region. This helps them to reach out to more users who now experience a much easier enrollment process in their native language. Health plan coverage details and information training videos also help to improve the overall user experience. All users in the system benefit from enhanced reporting with the ability to generate customized reports for Plan Sponsors, Administrators, Representatives and Members.

Regulatory Compliance

The healthcare industry’s HIPAA regulations for patient security and data privacy needed to be adhered to in order to ensure a fully compliant system. The audit tracking features built into the system also ensured the client could easily comply with auditing regulations.

Product Scalability

The application additionally possesses a scalable architecture to support the client’s future goals of product enhancements, integration across trading partners, and advanced reporting features.

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