nGeniusONE: Ending the Patient Eligibility Inquiry Bottleneck
Customer Company Size
Large Corporate
Region
- America
Country
- United States
Product
- nGeniusONE
Tech Stack
- Adaptive Service Intelligence
- InfiniStream appliances
Implementation Scale
- Enterprise-wide Deployment
Impact Metrics
- Customer Satisfaction
- Productivity Improvements
Technology Category
- Analytics & Modeling - Real Time Analytics
Applicable Industries
- Healthcare & Hospitals
Applicable Functions
- Quality Assurance
Use Cases
- Remote Asset Management
Services
- System Integration
About The Customer
The customer is a century-old healthcare insurance provider based in the Northwest U.S. The company serves millions of members across multiple states, providing preventative care, as well as treatment for health-impacting conditions. The company has a significant IT infrastructure that supports its operations, including the processing of patient eligibility inquiries. These inquiries are critical to the company's operations as they determine whether or not prescribed treatments are covered by insurance. Any slowdowns in this process can have a significant impact on patient care and can also put the insurer at risk for service level agreement (SLA) violations.
The Challenge
The healthcare insurance provider was experiencing significant network slowdowns that were adversely impacting application services used for patient eligibility inquiries. These slowdowns were causing delays for doctors and hospitals in determining whether prescribed treatments were covered by insurance. This not only impacted patient care but also put the insurer at risk for service level agreement (SLA) violations. The IT team was faced with the challenge of identifying the root cause of these network slowdowns in order to rapidly triage and improve the mean time to repair (MTTR).
The Solution
To address its network and application issues, the insurer’s IT team worked with long-term technology partner, NETSCOUT™, to pinpoint the root cause of infrastructure slowdowns. They used the nGeniusONE™ Service Assurance platform with Adaptive Service Intelligence™ (ASI) technology and InfiniStream® appliances. These tools offered critical traffic-based intelligence into service performance across primary and secondary data center locations, as well as at a new co-location that is currently being brought online. Using nGeniusONE, IT staff was able to gain visibility into the overall payer environment, from the Internet connection and firewalls to the application servers to the databases and storage. This allowed IT to triage and troubleshoot issues impacting communications from doctors and hospitals requesting patient treatment approvals and service privileges.
Operational Impact
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