TriZetto QNXT is a longstanding leader in Healthcare administration platforms, supporting many lines of business including Medicare and Medicaid. An important function of QNXT is its strength in claim pricing, member administration and billing management. However, the provided QNXT toolset lacks flexibility in adapting to new processing requirements. For example, it would be difficult to perform member lookup and replacement prior to processing through QNXT’s modules.
Understanding the Workflow
QNXT utilizes Microsoft BizTalk Server to intake EDI X12 837 claims and X12 834 enrollments that are utilized in its various modules. The files are translated from EDI to XML within BizTalk’s native EDI parsing pipeline component deployed as part of QNXT’s ‘QNXT Connect’ BizTalk Application. The XML is then sent into QNXT where it travels through QNXT’s built-in agents and modules.
However, it is often the case that custom logic is necessary to…
AI is one of the hottest trends in tech right now, and therefore it’s no surprise that there is literally an army of consulting companies out there right now who are ready willing and able to help clients pursue the dream of AI. However, with a saturated market comes the age old question of “do these guys really know what they are doing?” In a field like AI where the technology itself is often too complex to comprehend it can be very easy to partner with a company that says all the right things but doesn’t have the chops to back any of it up.
I recently read an article on Forbes that sought to help consumers weed out the charlatans by listing the top 5 questions to ask to ensure that an AI vendor can deliver results. Being an AI…
SignalR is a library in ASP.Net that allows the real-time updating of data between server and client. It proactively pushes content to connected clients instead of waiting for the clients to send a request. This can be leveraged to replace polling and eliminates the need to refresh pages. SignalR also allows management for connections between servers and clients to determine this real-time communication. This functionality can be used from anything ranging from, but not limited to, games to notifications. In this post, I will examine the basic components and set-up of SignalR for an ASP.NET Web App.
There are two main pieces to using the SignalR API: Connections and Hubs.
Connections are the endpoints that represent a user and are used to send content in broadcasts. They can be sent by themselves, or to groups of subscribed users, allowing for greater control…
Each day health plan administrators look forward to the challenge of loading 834 enrollments and 837 claims into their adjudication systems.
From a distance, it seems simple to report and reconcile the EDI transactions submitted by providers and clearinghouses through a plan’s intake workflow. Drilling into the steps along the inbounding process, challenges emerge which can present insurmountable obstacles to answering a question as basic as: How long has this claim been held up in my intake process?
TriZetto QNXT is a common adjudication platform we’ll use to illustrate this point. In a typical workflow, loading claims might involve:
Handoff: The day’s 837s are pulled from an SFTP server and moved to the start of the intake process.
Archive: Move files into processing workflow, and archive a copy.
EDI Structural Validation – Basic checks are performed to ensure the 837 transactions are well-formed. This level of validation is…
It’s taken a year for me to feel confident enough to even chime in, on a high level, about the products we’ve created, and the platforms we utilize. I can dabble in conversation about chatbots and Microsoft’s Cognitive Services. I understand now, more or less, what ‘the cloud’ is and its benefits. But, this is why teamwork makes the dream work, you know. My colleagues can build you a solution to any business challenge. Anything. You’ve got a problem, they’ll solve it.
But, now it’s my turn. I am going to express why what they can do matters.
You’ve all heard of Machine Learning. We partnered with RetailWire to produce a Webinar on ML for Retail back in April and that’s where my understanding really began to take shape. In a nutshell, Machine Learning can be set-up and do in minutes and…
Anyone planning to develop a VSTO Add-In may come to realize that documentation and examples are scarce or nonexistent. Recently I have found myself in this exact predicament as I have been developing a Microsoft Word VSTO Add-In to be used in the legislative drafting process. Throughout development, my team has created a handful of solutions for both simple and complex tasks. Many of these solutions could not be found online, and as a result, required significant research and testing. Here are a few examples that I wish I had when I started to develop a VSTO add-in that will hopefully jump-start your VSTO development.
Overriding Default Save Behavior
One of the core features that was required for our Word Add-In was version control. In order to support this functionality, we would need to override the default behavior of Word’s save functionality….
I attended UXPA Boston 2018, a one-day conference hosted at the Sheraton Boston. This was a highly anticipated event for me as it was my first year attending despite being interested in previous years. What’s more, this year’s conference happened to land on my birthday, so it was a real treat to break from the day-to-day routine!
I was especially looking forward to sessions by UXers from notable companies like LogMeIn, Google, and IBM on the topics of user research workshops, collaboration and the future of UX.
Attendees of this conference ranged from content writers, product managers to marketing professionals and beyond. I chatted with folks there, and it was interesting to learn how people in different roles and companies prioritized different topics.
Purpose Before Action – Why you need a Design Language System
Designers from IBM opened this session by outlining the definitions…
The genetic algorithm is part of a family of algorithms used for optimization problems first conceived of in the 1950s at the Institute for Advanced Study in Princeton, NJ. The algorithm didn’t gain much commercial use until the late 1980s. In this post, I will briefly discuss genetic algorithm and how it works, going over an example of its implementation. I will also discuss what practical problems genetic algorithm can be used to solve. Lastly, I will provide some links for more reading on the subject should you feel like learning more.
So, the Genetic Algorithm gets its name from the fact that it attempts to simulate biological evolution. If you recall from high school biology, all life is composed of DNA, and that DNA is made up of chromosomes, which are made up of Nucleic Acids. When an organism reproduces,…
SQL Server’s AlwaysOn technology (available since SQL Server 2012) provides high-availability and disaster-recovery database functionality which largely supplants mirroring and log-shipping – in fact, mirroring is now deprecated. Exactly what functionality is available and how robust it is, varies by release (2012+), edition (Standard versus Enterprise) and the physical infrastructure devoted to it. AlwaysOn is fairly easy to set up (though it requires cooperation from both Windows Server and networking admins) and, relative to the required effort, provides exceptional durability for SQL Server databases. AlwaysOn is not a complete OOTB durability solution and has significant gaps – e.g. it does not maintain SQL Server logins and roles synchronized across multiple servers – but it is an excellent start for the needs it caters to.
This post assumes the reader has at least a basic familiarity with SQL Server backups, as well…