Provider Self Service Portal

Decreased operational costs by giving providers sufficient detail to resolve 90% of questions they may have through self-service.

Challenge

Our client identified a need to build
the online Provider Portal System
enabling medical providers to check
member’s eligibility, get detailed
benefit information and perform
claim status inquiries 24/7, 365 days a
year.
The required eligibility, benefits and
claim status information are stored
on four independent systems:
1.NASCO (National Account Claims
and Membership Systems)
2.RTMS (Commercial Accounts
Membership System)
3.TPSU (Commercial Accounts Claims
Processing System)
4.Blue Exchange (Blue Cross Blue
Shield data management system)

Solution

In the project phase one Vicert
created a technical architecture
document detailing the complete
system design. In the project phase
two Vicert implemented the solution
by developing three major
subsystems of the portal:
XML API Framework
Performs necessary business logic
and acts as a content provider
exposing all of its features and
capabilities through Web Services
Provider Transaction Application
A web application that provides an
interface to medical providers and
uses XML API as a content provider
MTM Auditing and Reporting
Application
Provides complete tracking of all
activities in the API to be used in
reporting and auditing of
transactions and overall monitoring
of the system usage

benefits

• Architecture of the middleware
components
• Short time to architect and implement
the set of core features (5 months)
• The phased approach delivers a
customizable solution that innovative
projects are currently utilizing
• Cost benefits: 5 to 10x
• Greatly improved features and quality of
online, self-service capabilities made
available to the medical providers