DataBridge Use Case

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

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Luminous Development Group