Electronic Data Interchange
A State agency commission is responsible for administering and enforcing workers’ compensation regulations and adjudicating disputes involving injured workers.
The commission recognized the need to improve service to its constituents by bringing its legacy information systems into alignment with long-term commission goals. A primary goal of this alignment was to receive claims information from insurers electronically rather than via paper forms. As part of the larger technology program for which CapTech was hired, electronic data interchange (EDI) was the first and most important project.
Receiving data via EDI would allow the commission to track all worker injuries in the state and to ensure that all injured workers are provided with all required benefits. The ultimate goal of the technology alignment program was to use this information as the foundation for timely adjudication of disputes and to provide information to constituents, insurance carriers and their attorneys electronically.
More than 300 insurance carriers report daily injury and quarterly payment reports to the commission via EDI resulting in the commission receiving thousands of EDI transactions per day.
CapTech developed detailed requirements by studying state regulations, analysis of applicable EDI specifications, and extensive requirements gathering sessions with Commission leadership.
On CapTech’s recommendation the Commission retained an EDI aggregation firm to receive and validate EDI transmissions from each of the 300 insurance carriers before relaying that information to the Commission. CapTech worked closely with the outside firm to develop stringent EDI implementation guidelines for the carriers.
Internally, the Commission did not have IT systems suitable for the receipt, processing, and presentation of the EDI information to staff, attorneys, and constituents. Therefore, CapTech architected, designed, and implemented a robust transaction processing system to receive the transmissions, produce notifications, and initiate business processes based on the new EDI transactions and past transaction history.
Transaction in-take is orchestrated by a rules engine that applies business rules to the new and historical transaction data to determine the notifications and business processes to initiate.
Additionally, CapTech managed external communications between the Commission and concerned parties such as insurance carriers and attorneys, and managed internal communications to prepare Commission staff for the changes spawned by the new system and processes.
The resulting EDI system enabled the state to accurately track and account for workplace injuries and to provide the nation’s first publically accessible workers’ compensation system.
- JavaEE 5
- JBoss Application Server
- JBoss JBPM Business Process Management
- JBoss Portal Server
- SQL Server, Integration Services
- The nation’s first publicly accessible workers’ compensation system.
- Project delivered on time and on budget.
- EDI transactions from all insurance carriers now filed electronically.
- Full EDI functionality with notifications and business process support delivered exactly one year from project initiation.
- Several thousand EDI transactions reported nightly from over 1000 reporting entities via 300 insurance carriers.