Document Processing and Content Storage

CTG Implements Macess Product at Large Payer Organization

The Client

The Independent Health Association (IHA) is a large payer organization based in Western New York. Established in 1980, IHA consistently rates among the top health plans in the U.S. for customer service and member satisfaction. IHA’s offerings include HMO, POS, PPO, and EPO products; Medicare and Medicaid plans; traditional indemnity insurance; consumer-directed plans; coverage for self-funded employers; and health savings account (HSA) and pharmacy benefit management (PBM) services. The organization provides health benefits and services to nearly 400,000 total individuals.

The Business Challenge

IHA made the strategic decision to replace its image and data capture/storage software. This software platform and the scanning and archiving processes had been supporting virtually the entire organization for years. The goal was to replace Entrendex (a document scanning and Optical Character Recognition (OCR) application) and IMAX (a content repository/storage and workflow application) with new SunGard products (FormWorks and Macess). This would allow IHA to reduce administrative costs, improve HIPAA compliance, enhance security, provide for conversion from paper claims into EDI 837 file format, implement OCR for image capture, streamline business process, and improve customer satisfaction. During this time, IHA had also made the decision to replace its legacy claim processing system, Power MHS, with a new system, HealthRules.

IHA needed to implement both of the new products (FormWorks and Macess) concurrently and integrate them with Power MHS and HealthRules, allowing for coexistence within both claims processing systems. This project was a complete rebuild of the infrastructure (hardware) and rewrite of all the interfaces into FormWorks and Macess.

The CTG Solution

CTG managed the entire product implementation by working with the product vendor (SunGard), delivering the new architecture, building new interfaces, and integrating FormWorks and Macess within IHA’s other enterprise applications, including HealthRules, Power, and their CRM application, Siebel.

  • CTG collaborated with the other project teams, including teams that are part of the CTG technology partnership initiative, to deliver the required short-term and long-term solution for Macess integration with other enterprise applications.
  • The project team focused on delivering the minimum functionality that was needed by the business to support HealthRules releases (through Agile Scrum methodology) in a timely manner.
  • CTG resources demonstrated excellent skills in reverse engineering the old product interfaces to identify various components that required rewrite of the application interfaces.

The Results

CTG completed the project within budget and
on time to successfully coordinate with other
strategic project initiatives occurring simultaneously. With this project, CTG
delivered additional benefits, including:

  • Prior to this implementation, there was
    no adequate documentation available
    on IMAX interfaces. CTG created extensive
    documentation on the Macess product 
    integration into IHA’s enterprise
    architecture, including the integration
    with Power and HealthRules.
  • CTG implemented the project on time to
    support the content storage needs (store member correspondence generated by HPExstream product) and content storage requirements which were key to the
    success of the HealthRules implementation.
  • CTG was able to provide the key resources for the project—IT architect, ITproject manager, IT business analyst, IT QA, ETL Informatica developer, and SOA developer.
  • CTG helped to automate the Macess operations for document import and
    docflo.
  • CTG replaced a batch solution with a real-time interface solution between
  • Siebel and Macess that helped the
    Customer Service center to access the images
    in Macess in real time.