Standard Reports for CMS and Sponsors |
| The Task: |
| To design an application that acts as a valuable reporting interface between the client and its various kinds of vendors. |
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| The Challenges |
| To develop an application that would help in loading data of HMO’s reports that needs to be sent to the vendor. |
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| The Solution |
| Binary Spectrum designed a process wherein the interaction between the HMO and the vendors’ like the registered pharmacies, laboratories, etc, is through reports. Here, the inbound folder generates 834, 820 and 835 files to the EDS (CMS represents as the EDS for Medicare and ACHA for Medicaid). This further selects and processes files to outbound folder. The HMO can send active member reports to its vendor as a way of outbound file. The outbound folder generates files to the client server application. The entire process data is stored in a centralized EDI database. The EDI database forms the back end store and the EDI console forms the front end store. Any file can be accessed from the EDI console. |
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| The Result |
| The client has been able to use a standardized interface with its vendors, CMS, ACHA and sponsors. |
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| look at other HMO case studies |
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CRM: |
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Managing campaigns, events, leads and enrolling Medicare members |
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Managing website portal with regulatory content for compliance |
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EDI: Business to business platform for bulk transactions |
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Medical research administration for Medicare members |
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Online Analytical Processing |
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Health Reimbursement Arrangements |
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