Sometimes a routine assignment solves more than the original brief, providing the client with value-add they had not anticipated. In this case, the routine assignment was to update our health insurance client’s claims system for the World Health Organisation’s (WHO) bi-annual International Classification of Diseases (ICD) codes.
The value-add included a simple, left-of-field solution to a software incompatibility problem that threatened to create havoc in the client’s back-office support systems, plus a legacy of detailed process documentation, automation, and reporting frameworks that provide ongoing cost savings.
The first issue we encountered related to lack of internal process documentation, which had made the bi-annual code updates ‘take forever’ as one employee put it. Working with a BA, our consultant wrote and validated a detailed ICD-10 Update Guide and produced four related Excel templates that automatically create the SQL scripts from the electronic code lists, thus laying the ground to speed up future updates.
The second issue related to the incompatibility of next version 3M Core Grouping Software program (CGS Grouper) with our client’s claims system. The program enables the grouping of international codes into meaningful data for Australian needs. It had been updated to Java v7. Our client’s claims system sits within its back-office support system (BOSS) alongside other critical data streams for running the business. BOSS operates in a Java v6 environment. The claims system could not be updated to v7 without impacting all the other data streams – a lengthy and risky process.
With the mandated change just a few months away, our consultant turned to 3M to request CGS Grouper v9 on Java v6 – as a one off to buy time – only to find that this temporary fix had been provided two years earlier and there were no second chances. At this point, no one knew how to integrate the two systems.
Sometimes it takes an outside eye to conceptualise how things could be done differently, to look beyond the BOSS environment for a possible solution, and to ask different questions. Our consultant took his problem to the corporation’s internal Java resource. Between them they identified that the CGS Grouper was being invoked from a stored procedure within the BOSS Oracle database. This meant the CGS Grouper process could be moved to external servers without impacting on other critical systems. From there it was easy.
They isolated CGS Grouper into a separate string of servers, modified the Oracle stored procedure to link to the new location, wrote and system tested the code (in six weeks) and, in tandem, simplified the testing process by focusing on validating the business requirements of the CGS Grouper function, rather than testing the end to end claims lifecycle. Our consultant also documented the design and implementation of the Grouper servers, including operational support for the platform, license updates and installation of new versions of the software. (CGS Grouper Admin Guide).
The solution resulted in a smooth, on schedule, transition to CGS Grouper v9 and ICD-10 codes. The project came in 25% under budget. With the budget savings, the Envisian consultant was able to provide two management tools requested by the business to improve reporting and monitoring. The Grouper Dashboard and the Grouper Expiration Report.