BREAKING NEWS:  Our own Greg Johnston will participating in “The Government BPM Journey” panel on June 9th, starting at 2:45pm. 

Delivering Healthcare Solutions

ArchiTECH Solutions (ATS) has delivered healthcare solutions for Veteran Affairs (VA) and TMG Health using Pega BPM tools, as well as developing an optical character recognition (OCR) solution for healthcare claims processing.  ATS has helped improve business processes, created unique solutions to complex problems, and provided a broad range of technical services for issues particular to each client, especially as they relate to upgrading and interfacing with legacy systems. 

Team Of Doctors Examining Reports

ATS at TMG Health

Prior to our involvement, TMG was not satisfied with the existing technology infrastructure they were using to run the majority of their operations. Their legacy applications were not neither unified nor scalable, meaning TMG could not be responsive to their continued growth in the industry. Consequently, TMG looked to the open market to test a commercial-off-the-shelf BPM product that would allow them to re-engineer their current applications, restructure their existing backend and reach their market objectives.

TMG selected Pegasystem’s PRPC to be the platform to build their new enterprise, and ArchiTECH Solutions was selected as the preferred service provider to implement the entire solution.  The major problem encountered was that the client’s existing legacy system for managing plans, claims, fulfillment, eligibility, etc. was outdated and required a significant amount of manual interaction.  TMG required a solution that would be an automated process and would enable their systems to be available to their end client.

ArchiTECH Solutions served as TMG’s BPM expert and was tasked to deliver on specified objectives. Our business analyst team began by hosting several requirements gathering sessions, involving the business owners and coordinators to capture all case studies and specifications for the new product. Simultaneously, the ATS leadership team worked with the TMG leads and sponsors to coordinate the overall project deliverable and goals.

As the project started to move into the construction phase, the ATS BPM development team took over to rapidly deliver the quality and scalable solution that met the client’s needs. ATS used Pega and SOA technologies to assist TMG to successfully accomplish their objective.  Pega was selected because it had the framework that best fit TMG’s desired business model. SOA technologies were selected because this gave TMG the ability to create transparent and collaborative business services to be shared with their clients. The Pega platform enabled a solution for successful integration with existing 3rd party applications, databases, etc. within the TMG systems.  

ArchiTECH Solutions adheres to Pega, SOA, PMP, and CMS best practices. For the contract, Architech Solutions provided key business and technology leaders who are familiar with the best practices, so as to successfully implement and execute the contract requirements.

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ATS at Veteran Affairs, Financial Services Center  – Healthcare Claims Processing System

ArchiTECH Solutions was selected to participate as the preferred Pega services provider on the prime contract for the VA Healthcare Claims Processing System (HCPS). ATS provided a certified Pega solution development and delivery team to work with the VA FSC and Chief Business Office (CBO).

HCPS requirements detail a web portal solution for four aspects of Veteran healthcare services:  Eligibility and Enrollment, Referrals and Authorizations, Hospital Notifications, and Claims Processing. HCPS, as the sum of these interrelated applications and a forthcoming CRM solution, will support the medical needs of Veterans who are eligible for private-sector medical services.

For HCPS, ATS provides the following services:

  • Requirements discovery
  • Use case development
  • Full lifecycle of Pega implementation
  • Integrate Pega HCPS application with third party applications and legacy systems
  • Collaborate with Lead Systems Integration (LSI) team to enhance and troubleshoot PRPC applications
  • Review enterprise data class structure and provide detailed diagrams and mapping approaches
  • Establish a sound migration approach
  • Development of HCPS across versions of PRPC, with planning for future upgrades
  • VA FSC testing standards met prior to production (unit, functional, regression, 508 compliance, beta, UAT, and security)

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OCR for Healthcare Claims

Although most industries are moving toward paper-free processes, there is still a need to support industries that have not moved away from paper processes or that are mandated by law to continue to support them.  This is common in government services.

ArchiTECH Solutions offers an OCR solution for automating the entry of paper-based claims into Pega 7.x. The OCR solution enables standard forms to be digitally scanned at high speeds and run through a validation step in Pega to help eliminate paper handling and improve accuracy of claims records.  Not only is the data made available for processing in Pega, but the image of the paper form is also available to users for viewing.

ATS at PegaWORLD 2014

ArchiTECH Solutions will be at PegaWORLD this year, presenting more information about our healthcare solutions, as well as our COE solution.  Stop by our table to learn more and pick up some interesting swag. We’ll be the ones in orange.

BREAKING NEWS:  Our own Greg Johnston will participating in “The Government BPM Journey” panel on June 9th, starting at 2:45pm. 

How can we help you implement a BPM Solution for your Healthcare projects?

We have the expertise and the knowledge to help you find the best solution for your project.  We can even help you integrate a Center of Excellence if you are looking for a leadership-based solution that can help you streamline productivity and standardize processes.  For more information, contact us by email at orangebpm@architechsolutions.com.