"A SaaS based compliance and audit management system that helped identify, correct and achieve maximum compliance for healthcare plans. "

1. © 2012 Harbinger Systems . All Rights Reservedwww.harbinger-systems.com
A SAAS BASED MEDICARE COMPLIANCE
MANAGEMENT SYSTEM FOR HEALTHCARE
ORGANIZATIONS
rfi@harbingergroup.com ©2013 Harbinger Systems. All Rights Reserved
HSTC3310

2. © 2012 Harbinger Systems . All Rights Reservedwww.harbinger-systems.com
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HARBINGER SYSTEMS
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A Harbinger Systems Case Study
www.harbinger-systems.comrfi@harbingergroup.com ©2013 Harbinger Systems. All Rights Reserved

3. © 2012 Harbinger Systems . All Rights Reservedwww.harbinger-systems.com
A SAAS BASED MEDICARE COMPLIANCE MANAGEMENT
SYSTEM FOR HEALTHCARE ORGANIZATIONS
www.harbinger-systems.com
www.harbinger-systems.com
rfi@harbingergroup.com
Situation
A US based start up ISV in healthcare domain wants to maintain and
grow its leadership by creating an automated solution for Centre for
Medicare and Medicaid compliance needs for healthcare providers
BOTTOM LINE
A SaaS based compliance and audit
management system that helped
identify, correct and achieve maximum
compliance for healthcare plans.
Harbinger Solution
Developed a compliance rules engine based on a decision table methodology.
Business rules were defined, data fields associated with a particular compliance
rule were identified and mapped with the decision table.
Application deployed on SaaS model so that customers can enable / disable
rules and decision tables according to their specific needs for auditing and
compliance purposes
Real time compliance data shown in visually appealing formats such as pie
charts and tile view. Utilized Jasper Reports to extract reports in different
formats like pdf, xls, .doc etc.
Implemented a scheduler for automated system audits and calendar events for
users to assign, set frequency and schedule internal/manual audits. Application
sent automated email notifications to users assigned to handle various events
like compliance exception, assignment of exceptions and audits.
Integrated openKM as the document management system and a centralized
knowledge base. It provided role-based access and facility to
import, add, modify or delete internal documents along with search and
bookmarking features
Challenge
Manual process for understanding over 200+
business rules for compliance management
Develop a customizable and flexible model to
facilitate varied customer needs and frequently
changing compliance rules
Need for systematic reporting of real-time
compliance data
Provide a Scheduler based automated system
audit and calendar events for planning
internal/manual audits
Need for a central knowledge base for latest
compliance updates
Technologies & Tools
J2EE
Spring
JBoss
MySQL
CAS
Jasper ETL
jQuery
Benefits
A compliance rules engine facilitated in proactive identification and reporting results on
exceptions, for Centre for Medicare and Medicaid audit requirements
Improved flexibility and adaptability to changing rules at every health plan level
Enabled users to access the compliance level and drill down to specific compliance
exceptions easily in real time. The users could also track historical data for trends,
compliance and exceptions, with the help of customized reports.
Automated system audits & timely notifications led to increase in workforce efficiency
Implementation of a document management system resulted in improved information
sharing and knowledge management
©2013 Harbinger Systems. All Rights Reserved