Healthcare Payer Organization Case Study
This health insurance payer organization relied on three separate legacy systems – one for HMOs, another for PPOs, and a third for other plans – to process claims. Working closely with the company's internal IT team, EDS developed a phased migration plan to convert the company's existing processing systems to EDS' MetaVance®, a single platform that allows real-time claims processing. It also allows the company to implement changes in pricing, benefits and provider contracts simultaneously across its entire claims portfolio. In the first phase of migration, EDS migrated more than 3.3 million PPO claims to the new platform over a single weekend. Processing resumed seamlessly the following Monday, and the new system achieved a nearly 70 percent auto-adjudication on the first run.