Accountable Care Organization
Business Need: Create a Sharable platform to support data exchange across multiple provider organizations
Encourage physicians and hospitals to coordinate care
Provide data to EDW for Members, Providers and Claims
5 Sources with 30 + Source Files (Daily and Monthly)
Create extract views to send data to external partner
Books of Record
Business Need: Create an Enterprise Data Warehouse on the Netezza platform to support the creation of Clinical, Claims, Member, Provider and Product sources for internal reporting as well as external consumption
Business Need: Create a reporting datamart to support strategic reporting
Business Need: Provide a higher granularity for matching members identifiable with varying health care consumer keys from disparate data sources.
Refined direct/deterministic looks and mastered probabilistic (MDM- related) attributes
Business Need: Implement pharmacy and medical benefits authorization for MedHOK
Integrates with claims adjudication and back-end processes such as case management, appeals and post-service claim review
Enables efficient authorization determinations
Improved operational efficiency and effectiveness, return on investment, member and provider experiences, member health and overall quality by focusing our resources towards higher return activities, automating the lower return activities and redesigning processes.