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Eligibility Determination System for Child and Adult Health Insurance Program

Project:

Eligibility Determination for Insurance Program

Executive Summary:

Introduction

• The system comprises a web-based interface for entering applicant information, accessible to each business partner and the client.
• The web-based interface provides for application entry and application maintenance using industry standard technology and architecture, and provides for high availability and scalability.
• The system also employs a "Batch Processing" component to determine eligibility of applications from potential participants in an offline mode during predefined batch processing schedules.
• The batch processing schedule runs predetermined business rules; the business rules are configurable through a "Rules Engine".
• The core of the system uses Internet based EDI to communicate with Business Partners using HIPAA. The solution employs a popular EDI & HIPAA tool from Microsoft, BizTalk Server 2002.

What was the Problem?

• Extremely difficult to use and master, the system was not intuitive, and had serious performance problems due to architecture and design flaws.
• Required extensive maintenance programs increasing the TCO (Total Cost of Ownership) for the client.
• The system was not robust and was not scalable beyond 50 users.

Aviana's Solution

• The Client Tier consists of HTML and Client scripting technologies to render the user interface.
• The Presentation Tier is responsible for generating dynamic HTML content based on user interactions and business rules implemented with Microsoft ASP technologies using IIS 5.0 web server.
• The Business Tier consists of COM+ components encapsulating Business logic and deployed in Microsoft COM+ runtime.
• The Data Tier consists of an Industry standard Relational Database Management System (Oracle 8i).