Delta Dental of Michigan, Indiana and Ohio: Realtime Claims

InSemble helped Delta Dental of Michigan, Indiana and Ohio launch their real-time claims integration for their core Claims ETS system.

This solution enables clearing house partners have an 'always on' capability to submit claims and access electronic explanation of benefits (EOBs) and provide the most up to date balance and billing information to dental offices. As a result, Delta Dental of Michigan, Indiana and Ohio will realize significant cost savings from real time claims submission and electronic EOB generation and will field fewer calls from providers to determine payment calculations.

This solution is built using a service oriented architecture approach and technology stack. InSemble helped identify reusable business processes and components for storing and processing claims and generating electronic EOB's within the current claims ETS system. These business processes and components were service enabled and exposed through an enterprise wide Oracle Service Bus to our external partners.

Oracle Service Bus provides the ability to integrate partners and onboard them with their unique business and technical integration requirements quickly and efficiently. InSemble integrated the Oracle Service Bus with the existing claims business processes and services within a span of few weeks of effort. Additionally InSemble helped effectively utilize the existing features and capabilities of the Oracle Service Bus for overload protection (throttling), business exception management and recovery, monitoring, reporting and alerting using the service bus dashboard.

By recommending and architecting the solution leveraging an open infrastructure platform over an expensive EDI based vertical solution, InSemble helped Delta Dental of Michigan, Indiana and Ohio realize significant cost savings and provided the foundation to onboard new partners in a rapid fashion.