Health Payer Core-Admin Integration Case Study

This case study details the integration of a midsize health payer's Core-Admin platform with Claims1TM.BenefitsConfig to address significant operational challenges. The health payer faced issues such as data redundancy, inefficient onboarding of new team members, manual errors during product builds, and data inconsistencies. To tackle these challenges, a pre-project was executed in collaboration with Simplify Healthcare, which involved providing over 23,000 products from the Core-Admin system and configuring two sample products with a customized workflow. The integration was validated through test claims, demonstrating the system's capability to transmit data effectively. The project was completed within eight weeks, utilizing less than 40 hours of subject matter expert time. The results showed a marked improvement in product build time, quality scores, and team efficiency, with significant reductions in average renewal time per product and enhanced data reusability. This case study illustrates the successful application of technology to streamline health plan operations.