Virtual Appeals Manager (VAM)

Virtual Appeals Manager (VAM) is a web based application that enables efficient and compliant Appeals & Grievances operations throughout the entire lifecycle. The application extended the product line for the Digital Health client beyond the compliance manager tool they already had.

Challenge

The major challenge was to provide an
application that helps payer entities
process appeals and grievances in
a way compliant with the law. The
application had to provide high level
of customization so that it can support
need of various risk-bearing entities
like Medicare, Medicaid, Commercial,
Health Insurance Exchanges, ACO’s
and other. Since the solution was
built as a product to service multiple
clients, it had to be built in a way that
was highly configurable based on
each of our client’s clients’ needs.

The first product created by the client
was built as cheaply as possible and
the quality was commensurate with
what they paid. Under the hood was
spaghetti code and they needed their
second product to “lead the way” from
a technology platform perspective.
Which is why, we needed to build out
the technical platform on top of which
all future products could sit for easy
integration with one another.

What were the biggest risks?

Requirements were delivered to us
as a mock up using MS Access, which
contained about 20% of the actual scope
of the project. Working in lockstep with
the Chief Compliance Officer in an
Agile fashion, we were able to ferret
out the remaining requirements and
deliver a solution that exceeded their
expectations for the dollars spent.

Solution

We created a Java based web
application based on Spring and
Hibernate frameworks. The solution
included a configurable workflow
enabling detailed customization
and configuration of all aspect
of workflow, with a performing
automated evaluation and decision
based on Red Hat Drool rules engine.
Using Agile Scrum project
management methodology, we
helped client to define and prioritize
product features and successfully
manage project through entire
lifecycle. We deconstructed the
existing product to understand the
application and its architecture. Based
on findings and long term plans, the
team made recommendations on
technical architecture and approach
to allow flexibility for future product
integrations.

benefits

Using Agile Scrum approach we
were able to create MVP in 6 months,
enabling our customer to start with
ROI. After 9 months they had a version
1.0 that they could begin deploying
to customers.

Solution is highly configurable and
customizable so that it can support
multiple workflows and entities like
Medicare, Medicaid, Commercial,
Health Insurance Exchanges, ACO’s
and other.