The Challenge
The leading patientcare company plays a vital role in delivering care services to thousands of members daily. However, a significant challenge they faced was the need to verify insurance eligibility for each member before rendering any care service. The company offered various care services, conducted health surveys, planned follow-ups, scheduled appointments, and coordinated care activities. Despite categorizing members into different groups and attempting parallel checks, the process of daily eligibility verification was extremely time-consuming, taking nearly 18 hours. This lengthy eligibility checking process hindered the company’s ability to plan and deliver immediate services to patients in need.
The Solution
To overcome this challenge, a comprehensive solution was engineered leveraging Azure services. The process of checking eligibility for all members was transformed from its previous Talend-based setup to Azure.
Azure Service Bus Integration: Each member’s information was converted into an Azure Service Bus Queue message, triggering web API calls to Athena Health for eligibility checks.
Serverless Processing: Azure Logic Apps, in a serverless implementation, processed almost 800 messages per second. This included filtration logic and delays, allowing Athena Health to efficiently gather and parse the insurance eligibility information.
Optimized Database Handling: The bottleneck of inserting eligibility information messages into an Azure SQL database was eliminated. Batching the messages and inserting batches of 500 into the database significantly improved processing efficiency. The batch JSON was parsed to write individual rows in the database table.
The Result
The transformation to Azure-based processing yielded remarkable results. The eligibility checking process, now running with concurrency enabled, was completed in just 3 hours. This represented an astonishing 83% reduction in processing time compared to the previous 18-hour timeframe. As a result, the care team gained the ability to access insurance eligibility status for a member at the start of their day, enabling them to schedule same-day appointments with providers and offer timely care services to their members.
This client success story exemplifies how the adoption of Azure services revolutionized insurance eligibility checks for a leading patientcare company, significantly reducing processing time and enhancing the company’s ability to provide timely and efficient care services to its members.
Tools and Platforms Used
