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Case Study: Integrating Healthcare EDIs

Electronic data interchanges (EDIs) were created to replace paper processing, decrease human error, and automate data entry. Today, EDIs are found across industries, including government, retail, and healthcare. For healthcare companies moving from paper to electronic processes, integrating EDIs between entities is an essential part of the project. However, EDIs are written in archaic code, lack adequate documentation, and aren’t as easily integrated as modern APIs.

A habilitative for-profit healthcare company came to Ventive ready to streamline its insurance claim process and improve its workflow. Their previous processes were entirely on paper, and the company couldn’t collect the data they needed to see how effective their services were. They wanted more data, a faster insurance process, and reduced errors in insurance claims. Unfortunately, standing between the company and a streamlined insurance claim process was Molina Healthcare’s distinctive and esoteric EDI.

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Healthcare EDI Prevents Project Integration

A major priority for the Idaho-based company was improving its health insurance claim process. Running a habilitative for-profit company using pen and paper was hampering their scalability. Since the average error rate for insurance paper claims is 28%, the company’s growth was blocked by human errors and processing delays. As part of their business process overhaul, the company prioritized switching from paper claims to an EDI format to securely transmit protected health information (PHI).

With a patient population entirely reliant on the same kind of health insurance, the software that Ventive was building for them needed to seamlessly integrate with Molina Healthcare. Unfortunately, the project hit a snag when the project manager couldn’t find a developer who understood Molina’s arcane system. It needed a developer who understood not only the general EDI standards but the standards specifically for Molina and this company’s particular case.

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Ventive’s Custom-Built Solution

It’s not unusual to have delays in healthcare EDI integrations because finding a specialist is difficult. That’s one of the reasons entire firms specialize in integrating healthcare EDIs. Unfortunately, using them is often cost-prohibitive for smaller companies. As Ventive started to automate the company’s insurance claim process, the Ventive team realized that our developers needed their full-time attention on the integration process. The information about integrating with Molina’s system was scattered across technical manuals and in online developer forums, and the knowledge gap was too big for part-time developers. 

Instead of hiring a healthcare EDI developer, Ventive’s technical PM decided to become a specialist. He taught himself how to integrate healthcare EDIs so that he could direct a specialist and back-end developer on the project.

“Even though this project was really complex, development-wise this has been one of the best teams we’ve ever put together. There were never any regression bugs, and the team was incredibly efficient.”

The Result: Seamless EDI Integration with Molina Healthcare

This EDI integration was only one step in our client’s business transformation, but it was a substantial hurdle for our developers to tackle. Now Ventive developers are unique in being one of the few software teams that can fully integrate healthcare EDIs. As the Ventive team continues to overhaul the healthcare company’s paper processes, they can focus on the next stage of development, including building out scheduling, payroll management, and time tracking management. This is the kind of dedication the Ventive team brings to every project.

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