The Challenge:
A healthcare Third Party Administrator has 11 Pharmacy Benefit Managers (PBM’s) and must integrate the core system with each of them. Each PBM has a custom interface process with unique file formats for their claims, eligibility and accumulator files.
There are multiple challenges that arise with this scenario:
- Customized programming required of the TPA’s IT staff multiple times over
- Fragmented development approach to account for 3 unique interfaces for each PBM integration
- Extensive partner testing drives an extended timeline in the onboarding process
- Elongated, multi-team effort onboarding results in high cost
- Decentralized operationalization of file processing resulting in negative customer impact
The Solution:
Leveraging DataBridge as an enterprise integration platform allows the Third-Party Administrator to effectively centralize and standardize the PBM data flows into a single hub for subsequent operationalization via the DataBridge management interface.
The DataBridge solution successfully:
- Consolidated 14 Eligibility data flows, 20 Claims data flows, and 6 Accumulator data flows into a single configurable hub
- Centralized data access from core system for all data flows enabling easier management of client/PBM movement and generating economies of scale
- Standardized data flow logic, operational management, and data source integration points
- Optimized trading partner testing windows & subsequent onboarding efficiency
