The proof of the pudding, as they say,                            is in the eating.

Provider Portal

The Client

One of Michigan’s Largest Medicaid health plans, serving over 140,000 members in 19 counties.

Business Situation

The plan’s vision was to improve customer services to its entire customer base - the state of Michigan, participating health care providers, and patients/members - and impact savings. The idea was to facilitate an easy and secure online access for health care providers. By using technology to process insurance claims, the plan would be able to eliminate the daily avalanche of repetitive eligibility and claim status calls and decrease the cost of mailing monthly status reports to providers. Additionally, the plan’s management recognized the strategic advantage of defining a solid architecture today as a base for future applications. Rapid development of the primary functions, and the ability to layer future functions over a stable foundation was crucial – strategically, and in terms of cost containment.

Services Provided

  • Application Architecture and Strategy
  • Integration Architecture and Strategy
  • Detailed Design
  • Advanced Software Development
  • Project Management

Our Work

Just prior to beginning the project, one of the largest health companies in the country acquired the plan. In order to proceed with the portal initiative as scheduled and avoid lengthy delays inherent in restructuring through an acquisition, a compelling business case and evidence of a high short-term ROI was required. X by 2’s expertise in pre-built but adaptable and pattern-based modules, their proven reusable ideas, and their ability to deploy all of the project phases in just eight weeks, were impressive and major factors.

Utilizing industry best practices, the plan’s provider service functions were developed on top of X by 2’s .Net based portal platform, and integrated with the plan’s existing backend systems – Trizetto’s Facets. This forward-thinking strategy leveraged agile architecture and design techniques, which increased flexibility, and translated directly into reduced Total Cost of Ownership.

External functions, those relevant to the medical providers accessing the plan’s website, were developed as small applications built upon a multi-layered architecture. Functions included: Positive and secure identification of site visitors, the ability to gather specific information about the medical provider, the ability of medical providers to verify patient eligibility and coverage, and to review the standing of submitted claims by patient name, date of service, or billed amount; Online statistical reports per provider, and printable patient communication forms.

Internally, tracking mechanisms and usage reports providing real-time statistics on frequency of use, functionality accessed, and the time involved in each transaction were put in place.

Benefits Realized

  • Architectural foundation to add new features and functionality with ease
  • Realized cost and time savings from reduced call center traffic, printing, and mailing of provider reports
  • Improved customer service by providing a user-friendly and informative web portal tool for physicians and hospital staff to access
  • Low Total Cost of Ownership – initial construction, evolution and extension, and ongoing support and maintenance of changes to requirements and new features and functionality