Web Enabled Eligibility Project

Congratulations to our team of consultants on their successful start of a highly sophisticated and complex web enabled eligibility project for a South East Health Care System.

The objectives of the project include:

• Minimize usage of SMS HDX processing in an effort to reduce expenses.
• Provide support for Cigna, Humana, Aetna and standard X12 eligibility data records.
• Design the system to be able to support additional input sources as necessary in the future.
• Integrate the Eligibility Inquiry functionality into the SMS Invision pathways.
• Provide an Intranet/Internet inquiry mechanism for enterprise wide inquiry capabilities.
• Provide statistical reporting capabilities.
• Maintain historical data for account follow up purposes.

The design of the eligibility project includes the following components:

• Develop a data dictionary to describe the eligibility data maintained in the Oracle based database.
• Develop SQL to define tables in the Oracle database.
• Develop ASP based web pages for browsing inquiring on the eligibility data.
• Develop programs to read the Cigna/Aetna/Humana/X12/other input data sets into the eligibility database.
• Develop custom COBOL CICS/OAS programs and modify Invision pathways to utilize the new eligibility database.
• Document the entire process.
• User training.
• On-going support services.