At a Glance
We partnered with a leading healthcare insurance company to implement a solution for their claims data accessibility needs. The project focused on delivering comprehensive historical claims data to the Epic Payer Platform (EPP), spanning all Medical, Pharmacy, and Lab claims from 2015 to present, including both paid and rejected transactions.
The Client
Our client, a leading health insurance provider in America stands at the forefront of healthcare innovation, delivering exceptional patient care through integrated, data-driven solutions
As a nationally recognized leader in the healthcare space, they combine clinical excellence with technological advancement to create seamless health experiences for their communities. Their commitment to quality, innovation, and patient-centred care makes them a valued partner in transforming healthcare delivery for the digital age.
The Challenge
Overcoming Data Integration Barriers
Our client's vision for delivering comprehensive claims data to Epic Payer Platform faced significant technical challenges:
- Massive Data Volume & Complexity: Processing years of historical claims data while maintaining performance required an innovative approach beyond traditional methods
- Cloud-Only Data Requirements: All data needed to remain within Google Cloud, eliminating traditional ETL-based solutions as viable options.
- Real-Time Access Demands: The system needed to process and transform claims data on-demand without preloading or materializing it.
- Data Quality Inconsistencies: Medical data accuracy depended on operators entering it correctly, creating quality control challenges that required systematic resolution.
Our Transformative Solution
Denodo Data Virtualization
We implemented a sophisticated Denodo Data Virtualization solution that revolutionized how our client processes and delivers claims data:
5-Layer Architecture for Maximum Efficiency:
- Base Layer: Provided streamlined access to raw claims data in Google Cloud.
- Filtered Layer: Applied date and claim type filtering to optimize processing resources.
- Eligibility Layer: Validated claim eligibility to ensure only appropriate claims continued through the pipeline.
- Transformation Layer: Intelligently pivoted diagnosis codes, surgical data, and drug information while standardizing data structure.
- Final Processing Layer: Performed rigorous quality checks and segmented data into specialized files for demographics, procedures, diagnosis, pharmacy claims, service lines, and eligibility.
Real-Time Processing Innovation: Enabled on-demand querying without intermediate storage, pushing computations to optimize performance.
Embedded Quality Control: Sophisticated validation schemas built directly into the data processing workflow, isolating problematic data before it reached Epic and reporting issues to data custodians for source correction.
The Game-Changing Results
The Denodo Data Virtualization solution delivered exceptional outcomes for the healthcare insurance provider:
- Unprecedented Processing Scale: Successfully processed over 360 million unique claims in just one week.
- Near-Perfect Accuracy: Achieved an extraordinary 99.96% accuracy rate, with zero defects reported after implementation.
- Accelerated Platform Adoption: Pre-validated data required minimal further processing by Epic, streamlining integration.
- Ahead-of-Schedule Delivery: Denodo's performance optimizations and the streamlined data flow enabled project completion earlier than planned.
Testimonial
“It was a pleasure working with the IQZ team as they delivered a robust platform for our member inquiries using Denodo on the Google Cloud Platform. They are dedicated, highly skilled and innovative in delivering technology solutions for their customers." - John Torquato - Manager IT
Conclusion
This groundbreaking approach to claims data integration establishes our client as a healthcare data technology leader, strengthening their ability to provide nimble, analytics-driven patient services while maintaining uncompromising data quality and system efficiency.
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