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Customer Story: Healthcare

Pediatrix Medical Claims Reporting is 80% Faster with Actian Data Integration

Inability to integrate data from multiple sources caused bottlenecks and delays in patient insurance claims processing.
Actian DataConnect Data Integration created a single source of truth for improved claims processing.
Reduced medical insurance claims reporting time by 80 percent, running reports in as little as five minutes, reduced the time to resubmit claims rejections, and quicker turnaround on payments.
About Pediatrix
Leading provider of newborn, material-fetal, and pediatric physician subspecialty services

From the first months in the womb through infancy and early childhood, human beings develop in ways that are essential to survival and a healthy life. The quality of healthcare services received during this critical time have a life-long impact. Pediatrix Medical Group was founded in 1979 to meet this need. It has grown to become America’s leading provider of maternal- fetal, newborn, and pediatric sub-specialty physician services.

With a highly productive visual design environment to print process flow charts, see how a process works, and add comments. By documenting code as they go, Actian DataConnect promotes reusability and eliminates the time and cost of maintaining custom coding. Actian DataConnect simplifies and speeds new integrations through dynamic discovery of field metadata and customizations. It also monitors integration server and execution status to help ensure smooth data flow without disruption.

For Pediatrix, having the right healthcare IT strategy and solutions has made it possible to innovate its patient service delivery models and achieve growth while providing high quality and cost-effective services. In the early 2000s, Pediatrix foresaw the need for heightened technology to manage the complexity and scale of big data in the rapidly changing healthcare environment. Company leaders teamed up with Actian, adopting Actian DataConnect™ to address this challenge.

Physicians under the Pediatrix umbrella are supported by clinicians and business professionals. It’s a collaborative effort to provide the best patient services, backed by ongoing research, education, and quality improvement initiatives. This requires a flexible and scalable healthcare IT environment in which large volumes of disparate data can be managed with speed and efficiently.

Automated end-to-end claims processing: With Actian DataConnect in place, Pediatrix turned its attention to claims processing, an area of significant complexity and cost for the company, particularly since it has seen a three-fold increase in its affiliate base in the last eight years.

Pediatrix works with multiple clearinghouses – sending insurance claims and receiving claims status reports – to handle the increase in claims processing volume. Each clearinghouse employs unique and complex formats in generating reports.

Before implementing the Actian platform, lack of data integration between internal applications and clearinghouses caused breaks in information flow. This bogged down the claims review and reporting process, and created a disconnect between reporting and other process steps in the Pediatrix patient life cycle. The company’s developers lost valuable time deciphering code and lacked the right tools to provide process flow information. As the volume of the claims increased, these challenges grew more severe.

Actian provided Pediatrix with a way to automate its end-to-end claims processing. Using Actian DataConnect, Pediatrix now can integrate, migrate, sync, validate, standardize, and enrich all of its claims data on a single platform. This made it possible to improve claims reviews and reporting while integrating this step with other business-critical process.

For Pedatrix business analysts, IT staff, and developers, Actian DataConnect established an event-driven, message-based infrastructure on which the company can connect to any data with greater visibility and control of the data integration environment. Actian DataConnect transforms all the data and presents it as a single database table. This has reduced the time, resources, and risk of error involved in reporting, especially when medical claims are rejected and reports indicate that they must be resubmitted.

Accelerate the Process, Improve the Quality: “With DataConnect, we can create mapping for each report and form them into a single database table that users can process,” said Jennifer Arriza, Director of Applications, Pediatrix Medical Group. “It takes five minutes to run the report and there is only one report to process; it is uniform and much easier to manage.”

With all of the codes standardized into a single database table, Pediatrix has gained a single source of truth for better data quality in its claims processing. There’s no need to recode processes because Actian DataConnect requires that only the transformations be adjusted. Developers have recouped valuable time to focus on other business-critical initiatives.

Using Actian DataConnect, Pediatrix has reducecd medical insurance claims reporting time by as much as 80 percent, running reports in as little as five minutes. Pediatrix also has reduced the time to resubmit claims rejections. In addition, reports now can be posted automatically to Accounts Receivable for quicker turnaround on payments. These improvements ultimately benefit providers and their patients, who are connected to the Pediatrix network of affiliates, with improved services.

Today, Pediatrix and its affiliates collectively employ more than 2,350 sub-specialists and advanced nurse practitioners across the nation. The infinite connectivity, limitless scalability, and reusability provided by Actian DataConnect has paved the way for Pediatrix to pursue future opportunities for data integration and analytics across the enterprise. Increased automation has reduced risk of error while improving business responsiveness. With the time savings realized with the new Actian solution, Pediatrix is exploring new ways to innovate delivery of patience services across the continuum of care.

"With DataConenct, we can create mapping for each report and form them into a single database table that users can process. It takes five minutes to run the report and there is only one report to process; it is uniform and much easier to manage."
Jennifer Arriza, Director of Applications, Pediatrix Medical Group
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