Automated processing of healthcare benefits enrollment (EDI 834 files) with CloverDX

Описание: A case study example of how one CloverDX customer automated the process of benefits enrollment, building automated data pipelines that ingest EDI 834 messages, and automatically validate and process them.

The client manages benefits enrollment activity for employers. Specifically, this means managing the process of people filling out forms to change their coverage, acting as an intermediary between health care consumers and the insurance provider.

Automating the data pipeline for our client here meant establishing a series of data enrollment events, so the pipeline would handle all stages automatically:

Accepting events in the form of EDI 834 formatted messages (the standard for healthcare benefits enrollment transactions).
Validating the message format. If messages are invalid, return them for correction.
Processing messages if they are valid. This is done by comparing against current records and dispatching valid requests to the associated healthcare insurance company.
At the same time, creating automated audit reports of everything that happened. This means the customer can now see which reports are accepted or rejected, as well as what changes were made.

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