Integration+™
Seamlessly integrate all your systems and data

Integration Plus™/Integration+™ Product offers health plans a complete, end-end software as service solution to seamlessly integrate with various Health plan and Health Plan partners, alleviating the burden of managing data exchange and transformation between Health Plan claim processing platform, upstream and downstream applications. It is a fully managed, secure, cloud-based enterprise integration platform, accelerating application development, ecosystem deployment, and maintenance of cloud services, data, and B2B integration processes. Serving as a robust, enterprise-class middleware platform, it is built on open-source and Java-based technologies, supporting various integration protocols including SOAP, REST, files, FTP, SFTP, HTTP(S), and more. Integration Plus™/Integration+™ supports Medicare, Medicaid, CHIP, FEP, Commercial, Fully Insured and Self-funded groups, Administrative Services Only (ASO’s) and Health Exchange (HIX) lines of business for medical and all specialties such as dental, vision and behavioral health, crafted to seamlessly integrate, scale, and adapt, providing an unparalleled solution for health plans looking to optimize their operations.

  • Pre-built Integrations

    Out-of-the-box functional APIs to facilitate quick development and delivery of new digital solutions, reducing migration risks.

  • EDI Solution

    Supports the exchange and transformation of messages, workflow configuration, testing, and monitoring of transactions. Effectively integrates with stakeholders, such as vendors, suppliers, distributors, partners, and marketplaces. Validates messages against customer business rules, ensuring data accuracy, and enriches data before forwarding to the sender. Enables real-time or scheduled data transfers, automating EDI processes to connect, transform, and route various document types between applications. Processes ANSI X12, DFF, and PFF standards, orchestrating data in these formats and accelerating stakeholder onboarding. Provides business intelligence on message transfers, empowering informed decision-making.

  • Data Hub

    Data Hub is an operational data store that is built as a proprietary payer data model. It is a centralized and standardized data repository that contains near real-time, cleansed, and validated data from the Core Administrative Processing System (CAPS) and other key platforms in the Health Plan's ecosystem. Data Hub enables the Health Plan to access, analyze, and leverage data from various sources and domains, such as claims, membership, provider, clinical, financial, and quality with ease and consistency.

    Data Hub uses a robust and scalable data architecture that integrates data from multiple sources and formats. Data Hub applies data quality rules and business logic to ensure the data is accurate, consistent, and complete. Data Hub also provides data governance and security mechanisms to ensure the data is compliant, protected, and auditable. Data Hub supports various data consumption methods, such as dashboards, reports, extracts, and APIs, to deliver data to the end users and applications.

    Data Hub is a relational database that enables transaction processing much more efficiently than CAPS data warehouse, built as a star schema data model. The Data Hub data is replicated near real-time with data replication software from the CAPS data warehouse and CAPS OLTP (Online transaction processing) to provide complete data needed for transaction processing.

  • Pulse

    This feature maintains the balance and control of data in various business value streams.

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Key Features

Integration Excellence

Seamlessly integrates Health Plan claim processing platform with inbound and outbound interfaces, fostering a cohesive and streamlined payer ecosystem.

Data Mapping and Transformation

Tools and capabilities to map data between different formats and structures, enabling seamless communication between systems with varying data schemas.

Real-time Web Service Calls

Handles real-time web service calls effortlessly using APIs, ensuring quick and accurate data exchange between systems.

Audit Trails and Reports

Maintains comprehensive audit trails and generates insightful reports for enhanced transparency and accountability.

Built-in Functional and Operational Capabilities

Offers built-in capabilities catering to all functional and operational needs, providing a comprehensive solution for the payer ecosystem.

Configurable and Customizable

Highly configurable and customizable to adapt to the unique requirements of different clients and lines of business.

Scalability and Performance

Horizontally and vertically scalable to accommodate future growth and evolving needs seamlessly.

Integrated Monitoring

Proactively identifies errors, inefficiencies, and bottlenecks through integrated monitoring, ensuring smooth and error-free operation.

Data Validations

Offers a configurable platform for WEDI SNIP Constraints, ensuring the creation of EDI files compliant with HIPAA.

HIPAA

Fully HIPAA compliant platform integrated to a Network Operations Center and Security Operations Center.