Case Studies
Explore how we have helped healthcare organizations unlock revenue, reduce risk, and modernize their technology operations.
Regional Medicare Advantage Plan
Redesigned the encounter submission pipeline and implemented automated QC processes, increasing CMS encounter acceptance from 65% to 99% and recovering over $5M in previously unrealized revenue.
Result
65% to 99% acceptance rate, $5M+ revenue unlocked
National Part D Sponsor
Architected an end-to-end PDE intake, quality control, and response automation platform that eliminated manual processing bottlenecks and dramatically improved audit readiness.
Result
90% reduction in manual QC effort
Multi-State Health Plan
Built and scaled an HCC/Risk Adjustment data warehouse that improved RAF scores by 20%, enabling more accurate revenue forecasting and optimized risk adjustment submissions.
Result
20% RAF score improvement
Humana Medicare Plan
Implemented a new Medicare health plan from the ground up, including claims adjudication, eligibility management, and CMS data exchange — delivered on time and within budget.
Result
Full end-to-end plan launch
Integrated Provider Network
Redesigned the electronic referral and authorization system, cutting approval turnaround time by 80% and significantly improving the provider experience.
Result
80% reduction in approval time
Multi-Specialty Provider Group
Built ETL pipelines across EMR, claims, labs, and pharmacy systems, replacing legacy flat-file processes with a modern, scalable data integration architecture.
Result
Real-time data across 4 source systems
Regional Health Plan
Developed eligibility import, physician profiling, and reinsurance data automation tools that generated over $1M in additional revenue and reduced manual analyst effort.
Result
$1M+ additional revenue generated
State Medicaid Managed Care Organization
Developed encounter and RAPS submission processes ensuring timely and compliant Medicaid reporting, achieving full compliance within the first quarter of deployment.
Result
100% compliant reporting within first quarter
National Managed Care Organization
Oversaw a complete data center rebuild including core software upgrades and infrastructure migration, achieving zero downtime throughout the transition.
Result
Complete rebuild with zero downtime