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Case Study

Benefits Inquiry Solution with Azure Logic Apps

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Industry: Healthcare

Solution: Application Development & Integration

The Client

Founded in 2005, HealthSun is a local Medicare Managed Care Organization with administrative offices located in Coconut Grove, Florida. Serving more than 40,000 Medicare Advantage consumers in Miami-Dade and Broward counties through its network of 19 wholly owned primary care and specialty centers, HealthSun is one of the fastest-growing health plans in South Florida.

Business Challenge

HealthSun, a leading healthcare insurance company with a focus on wholly owned care centers, faced an unprecedented challenge when the Centers for Medicare & Medicaid Services (CMS) mandated the implementation of a standardized benefits inquiry system. Despite not relying on external service providers, HealthSun had to meet CMS guidelines within a tight timeframe. This case study showcases the effective solution that emerged, combining compliance with regulations, cloud technology utilization, and streamlined implementation for long-term manageability.

The primary objective for HealthSun was to create a compliant 270/271 interface that adhered to CMS guidelines for benefits inquiries. Simultaneously, the project aimed to align with CAQH Phase II rules, encompassing real-time and batch interfaces, secure HPI communication via encrypted channels, and cloud technology adoption to minimize upfront costs.

Download HealthSun Case Study
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