A start-up company specializing in analysis of prescription
benefits provided by companies to their employees needed to
standardize its analysis methods and improve the productivity of
its analysts working from multiple locations. The client
received raw prescription data in multiple nonstandard formats.
The client would spend almost two weeks processing data into a
simplified format and then performing analysis on the data.
Often the analysis would be incomplete due to a lack of baseline
information, missing key data elements, or the timeframe
required for additional processing exceed the time available.
ISI was asked to replace the existing manual and Excel based
pharmacy claims analysis and audit process with a custom web
based audit management solution. The web based application would
provide a centralized repository for all information used in the
pharmacy audit and claims analysis process, with browser based
access to all audit management, analysis, and reporting
functions. The primary motivators for the development effort
included:
• The ability to support additional business through increased
automation
• Reduction and/or elimination of manual procedures
• Increased accuracy and timeliness of information
• Centralized access to claims information for cross client and
cross organizational analysis
• Foundation for future products and services
Integrated Services was engaged to provide all appropriate and
necessary resources required.
The web based analysis environment provided services from
multiple locations without large infrastructure investments. ISI
developed a multiple phase project plan that provided the client
usable deliverables at each step of development while ensuring
cost control. Additionally ISI would be asked to perform as the
IT department of the company throughout the project lifecycle,
to include hosting services during the development phase.
Based on identified business and technical requirements, the
following system software components were selected as the most
appropriate technical foundation for the new claims audit
management system:
Microsoft SQL Server – The centralized claims audit and analysis
database was developed utilizing Microsoft SQL Server 2000. SQL
server stored procedures were used extensively to automate key
system integration functions, significant batch processes, and
to simplify overall web front/backend end development. Data
Transformation Services (DTS) was used to automate the import
and refresh of First Data Bank drug information files.
Microsoft Analysis Server – Standard data analysis functions
were automated using the OLAP features provided by Microsoft
Analysis Services.
Microsoft Internet Information Server – Internet Information
Server was used as the web application deployment platform.
Visual Studio.Net – Microsoft Visual Basic.Net was utilized to
develop all front-end web based application interfaces and
back-end web services.
Crystal Decisions Crystal Reports and Analysis – All reports
requiring data from the SQL Server relational database where
developed using Crystal Reports and all OLAP/Cube reporting was
developed using Crystal Analysis. Both relational and OLAP
reports were published to the web via Crystal Enterprise for
browser based access.
Microsoft Excel – Additional analysis and reporting functions
were provided through the use of Microsoft Excel and its ability
to integrate with Microsoft Analysis server via pivot table and
charts.
