Inteq :: Customers : Case Studies

Client:

One of Canada's largest niche market providers of travel and health insurance products.

The Company, through its subsidiary, also provides assistance, case management, cost containment and claims services. The Company in exploring new avenues for growth has identified claims repricing domain as a future growth driver.

The Problem:

Claims repricing (Claim repricing is the application of a fee schedule to a medical claim and is driven by the payor or healthcare plan administrator's need to access a healthcare network's contracted discount rates), in a manual scenario, would encompass faxing or mailing in a paper claim for repricing, manual entry into a claims processing system - the whole process thereby involving several layers of personnel leading to a spiraling operational cost and longer process times.

The Company requested Inteq to provide a solution to reprice claims electronically with minimum human intervention.

Inteq's Approach:

Since the requirements were not well established, Inteq proposed a two phased approach. The goal of the first phase was requirements gathering, analysis and high level design of the proposed system. Inteq business and technical analysts helped develop the requirement specifications and design of the proposed system christened 'e-Repricing'. On completion of first phase a fixed price estimate was provided along with a detailed schedule.

The second phase involved project execution. To help implement the phases, Inteq adopted its established on-shore/offshore delivery model. The on-shore work included first phase, acceptance testing, implementation and support activities.

Solution Offered:

The requirements as recommended at the end of first phase included a system to assist the Company to reprice claims using its own automated or manual provider contracts and also provide option to electronically exchange claims with other contracted networks that are capable of repricing claims. The system is to have inbuilt capabilities to route claims to an appropriate network and receive repriced information with minimal user interaction.

Inteq in discussion with the Company recommended the approach of having two IT building blocks which include an EAI platform and a web application. The web application, clients and networks are to be seamlessly integrated, utilizing an EAI platform.

Gentran Integration Suite (GIS) was used as the EAI platform to receive, format and track claims. This platform orchestrates and launches the various programs in the web application in order to perform the required business rules.

The web application implements the core business rules related to repricing and was built on a Microsoft development platform. The application exposes some of the core business rules as web services and provides user interfaces to ACCPAC accounting system and Cognos Document Management tool.

Benefits:

e-Repricing system will facilitate the Company to electronically exchange claims information with clients, improve productivity in terms of claims management, bring new business and optimize cost

Inteq maintained and tracked the deliveries from a cost, schedule, risk and quality perspective. The key success factors were: well defined requirements, well defined worke-breakdown structure, project status tracking, independent quality assurance, and acceptance criteria tied to each deliverable.

Inteq helped the Company save over 40% in total project costs using a blended offshore/ on-shore model. The Company has decided to use this blended delivery model for other projects and has engaged Inteq as their offshore delivery partner in designing, developing and maintaining their IT systems.

The Client:

The Company develops and deploys sophisticated, high performance software applications, primarily for the healthcare industry. Their two flagship products LabWorks and WebvCMR are designed for laboratories and public health departments to maintain lab orders and track outbreaks.

The Problem:

Lab Works, WebvCMR and NCM require regular enhancements and upgrades to meet client requirements, HL7 and HIPAA compliance. Quality of the product releases became the major concern for the Company. To mitigate quality risks and streamline quality product delivery to its clients the Company wanted implementation of a proven and stable process for handling software testing of product releases across various clients.

The Company requested Inteq to assist in conducting an independent review of their quality system and procedures for product releases.

Inteq's Approach:

Inteq quality assurance team conducted review of the quality system and procedures in the year 2001. The study included all areas related to software testing and product release procedures. The study recommended refinements to the quality process which included:

Preparation of a comprehensive test strategy for system testing
Release management plan for QA, and Implementation
Preparation of test plans for scheduling and controlling test execution
Test case preparation and execution
Defect management to track defects to closure
Trace ability matrix to ensure test coverage
Preparation of test data to ensure comprehensive testing

Inteq adopted its established on-shore/offshore delivery model, wherein the approach was to evolve the quality assurance processes over several product releases with the help of the offshore team.

Inteq has over the last few years assisted the Company in implementing the quality process and systems without affecting the organization culture. This has helped in improved efficiency, reduced cycle times, increased customer satisfaction levels and reduced costs through off-shore work.

The Company has decided to use this blended delivery model for other projects and has engaged Inteq as their offshore delivery partner for software testing and quality initiatives. Inteq currently has a large team of quality consultants involved in end to end software testing of all products of the Company.

The existing ERP system for a major toxicology laboratory was custom developed in the early nineties using an older client server platform. It was not meeting the company's current business requirements. The company could easily triple their business volume, but were limited by antiquated technology. Attempts to customize a popular ERP package had cost over 2 million dollars but had totally failed to meet user requirements. Eventually this package was abandoned and Inteq was asked to provide a solution. Since the requirements were not well established, Inteq used its wholly owned subsidiary in the US (ACM Healthcare Technologies) to conduct a feasibility study. The goal of this study was to analyze and assess the existing ERP system, assess the preparedness to respond to future changes in business such as supporting new market requirements for clinical testing and support of the needs of other laboratories.

The specific areas studied in the assessment included the feasibility of a platform that is technologically current, easily maintainable and has the ability to easily grow and interface with a host of other customer information systems eliminating double entry, provide efficiencies in managing throughput, and better quality. Other objectives of the technology study was to enable management to have a real-time dashboard of performance, integrating financial, operational and customer information. The study recommended to include a data-warehouse that is seamlessly integrated with day-to-day operations to support data mining and trending. Based on the results of the assessment, ACM Healthcare Technologies proposed a three phased approach. The laboratory awarded Inteq the contract to implement the system.

To help implement the phases, Inteq adopted its established on-shore/off-shore model. The on-shore work included developing the requirements and aligning it with the laboratory process. On-shore work was performed by ACM HT, a wholly owned subsidiary of Inteq based in the U.S. ACM HT has strong understanding of the healthcare market and a solid expertise in HIPAA and other compliance regulations (21 CFR Part 11). ACM Healthcare Technologies' business and technical analysts helped develop the RFP, the contract and quality acceptance criteria for the deliverables. They provided a fixed fee estimate and schedule. The critical aspect of the proposal was well articulated deliverables with quality acceptance criteria.

While the laboratory's CIO had complete management oversight, ACM Healthcare Technologies maintained and tracked the deliveries from a cost, schedule, risk and quality perspective. The customer had the assurance of on-site management, cost efficient off-shore development and exchange moderators who oversees the service providers performance. The key success factors were: well defined requirements, well defined work-breakdown structure, project status tracking, independent quality assurance, and acceptance criteria tied to each deliverable.

Inteq helped the laboratory save over 50% in total project costs using a blended off-shore/on-shore model. The laboratory has decided to use this blended global delivery model for other projects and has engaged Inteq as their primary partner in designing, developing and maintaining their IT systems.