Enterprise Product Integration
using BizTalk (Healthcare)

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Client

A non-profit health insurer in the state of Hawaii and an independent licensee of the Blue Cross Blue Shield Association, and is the largest insurer in the state of Hawaii serving more than 700,000 people.

It offers a variety of health plans including Preferred Provider Organization (PPO) plans and Health Maintenance Organization (HMO) plans. HMSA offers plans through employers and individual plans for those not eligible through employer groups. Some health plans may include supplemental benefit coverage for prescription drugs and dental, vision and complementary care (acupuncture, chiropractic care and massage therapy)

Requirement

The customer’s IT initiatives were to build a single integrated platform for processing 837 claims and the acknowledgement which were earlier on two platforms WTX and BizTalk while keeping existing products up-to-date with respect to technology and business scenarios. They wanted to migrate their WTX deployed interfaces to BizTalk to achieve a single platform for integrating them. A phased approach was evolved towards coming up with a single, unified system based on Microsoft technologies.

Tools Used

Technology: NET, SQL server, BizTalk 2013, Microsoft Service Bus

Products integrated: Oracle, SQL, and Web Services

Our Scope

Focus worked with the customer towards evolving a long-term strategic roadmap that defined a phased approach towards coming up with a single, unified system based on Microsoft technologies and removal of their redundant products.

Simultaneously, Focus worked towards keeping the current integration between various products functional without really modifying the customer’s existing business processes. Focus also adopted a plug-n-play and de-coupled approach towards the integration to prevent over-dependence on any one product and for better security.

Enterprise Product Integration

Business Challenges

Integration of different products towards supporting and facilitating the customer’s business processes posed challenges in the form of:

  • Analysing and movement of the WTX developed interfaces to BizTalk without a proper documentation of the prior integration system.

  • Implementing any changes to the system due to continuously changing business needs contributed to high overheads.

  • Migrating 6000+ trading partners from WTX to BizTalk.

Strategic Roadmap

Focus worked with the customer in setting up a phased approach for solving these challenges:

Long Term:

Decision was made to move to a single, unified system based on Microsoft Technologies for managing smooth Claim Processing with their customer and multiple trading partners. A road map was defined with BizTalk Server, QUEST and CMS for seamless integration and scalability. All the short-term goals were defined to revolve around the long-term roadmap.

Short Term:

Major short-term requirement was to migrate the trading partners from WTX to BizTalk besides keeping the current integration between the various products functional without any disturbance to the existing business processes.

Technology Solution

Focus professionals worked along with the customer to deploy Microsoft’s BizTalk Server which helps in unifying the various products (in various locations) and streamlining information delivery among them. BizTalk also manages transactions and communications between external systems.

For seamless product integration, Focus decided to employ an XML based solution using Microsoft BizTalk Server 2013 R2 to facilitate the smooth processing of the claims and communication between internal and external systems. BizTalk Server 2013 R2, Microsoft Service Bus was used to manage and route the messages between them. This made it very easy to integrate the products. It also enabled to decouple them, preventing any one application from depending too much on the other or learning too much about the other (security and independence of each product being the benefits of this approach).

A unique party migration tool was developed to automate the trading partners migration from WTX to BizTalk.

enterprise product integration using BizTalk (Healthcare)

BizTalk Server 2013 R2 was also used to simplify and manage communications between order management product and systems at supplier organizations.

BizTalk Server made it easy to integrate with the company’s trading partners using XML. For those companies that still used EDI, BizTalk Server could take care of the XML-to-EDI conversion necessary to integrate with their trading partners’ legacy systems.

Key Benefits to the customer

Focus has been working with the customer for more than a year to help them achieve their strategic IT objectives. From being a vendor, Focus has now taken over the project– working along with the customer to define their roadmap, enabling them to meet their IT goals and hence deliver better and quicker results to their customers.

Focus team is the customer’s true extended team with a small onsite presence and the rest offshore, giving them a real and substantial cost advantage. The team is organized into Centres of Excellence (COE), and each COE focuses on one core technology area e.g., SQL Server, Salesforce, BizTalk Server etc. Resources are pooled from the COEs for any backward or forward integration efforts.

Each COE continuously works on the latest technology adoption that will support the business process in an efficient way. This ensures that the customer has up-to-date technical know-how to advance their business plans.

For all the integration efforts, Focus adopted the Plug-n-play and de-coupled approach to ensure that any changes made to the system in the future could be easily handled. These approaches also ensure independence of each product involved in the integration and makes for better security

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