CLIENT STORY

“Armed with robust EDI experience and a suite of products such as the HIPAA Accelerator, Tallan was able to provide APWU Health Plan the necessary tools to build an effective claims intake process with end-to-end visibility.”

THE CHALLENGE

APWU initially turned to Tallan for its BizTalk expertise with the goal of migrating their existing claims management system to Trizetto QNXT. But during the project, quickly realized they required more transparency and manageability for their overall claims intake process. Their needs included:

  • Migration to Trizetto QNXT Claims Administration platform
  • A variety of Claims enrichment function to be performed prior to claims ingestion as well as mid-process (Pre/Post Agent)
  • Lack of end to end visibility to Claims from receipt to acceptance in QNXT
  • Work through large files with throughput limitations

THE SOLUTION

Case study Solutions

Tallan’s EDI experience and suite of products provided APWUHP with the necessary tools to build an efficient and effective claims intake process. Some of the added benefits APWUHP realized from this project include…

  • Powerful enrichment model using familiar development tools
  • Data correlation model for tracking claims into QNXT provides end to end claims visibility
  • Minimize dependence on BizTalk and skillsets required to support it

OUR TOOLKIT

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