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Healthcare

Claims and national registries for a mandatory health-insurance system

A reimbursement engine, a national registry of insured members and a master-data hub with 200+ dictionaries.

The problem

Insured-member data lived in a distributed architecture, and reimbursement depended on it.

What we built

  • Reimbursement engine — adjudicates services delivered by providers and calculates reimbursement; the system's primary settlement tool.
  • National registry of covered members — one nationwide database, consolidated and migrated from a distributed architecture.
  • Master-data hub — single source of truth for reference data, 200+ dictionaries in active use.

Scope

Business analysis, iterative Scrum delivery, demos, staging and production rollout.

Client name withheld under NDA.

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GOOD TO KNOW

Frequently asked questions

What is the Claims and national registries for a mandatory health-insurance system project?

A reimbursement engine, a national registry of insured members and a master-data hub with 200+ dictionaries.

More selected work

What problem did this work address?

Insured-member data lived in a distributed architecture, and reimbursement depended on it.

What did Digital Gateway build?

; Reimbursement engine — adjudicates services delivered by providers and calculates reimbursement; the system's primary settlement tool.; National registry of covered members — one nationwide database, consolidated and migrated from a distributed architecture.; Master-data hub — single source of truth for reference data, 200+ dictionaries in active use.

What was included in the delivery scope?

Business analysis, iterative Scrum delivery, demos, staging and production rollout.

Which sector was this project in?

The case is categorized under healthcare.

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Which technologies are named in the case?

The published stack lists Java, national shared platform.

What team is listed for the project?

The published case lists 4 business analysts, 3 back-end (Java).

How delivery works

How was the system deployed or operated?

The public case does not provide deployment or operating details.

Is the client identified by name?

The case describes the client as National mandatory health-insurance system (regional funds, insurers, provider network). The public case withholds the client name under NDA.

Which Digital Gateway services relate to this work?

This case is tagged to Document AI and data pipelines and Platform and integration engineering.

Document AI and data pipelinesPlatform and integration engineering

Can Digital Gateway help with a similar requirement?

Yes. Share the intended outcome, existing systems, constraints and operating requirements so we can discuss a suitable delivery scope.

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