Enterprise Application Integration: A Case Study

by : Kristen Pucket

Brightree is the fastest growing provider of business management solutions in the Home Medical Equipment (HME) and Durable Medical Equipment (DME) market. In 2006 Brightree expects to process over $1 billion in claims and add a new customer approximately every other business day. Brightree is the only solution of its type endorsed by the 2,200+ member VGM service organization.

Because the DMERCs use asynchronous dial-up technology, the process was time consuming with frequent dropped connections. As their customer base increased, the issue of re-connects for dropped connections intensified.

In addition, the challenge of payor specific edits was continuing to affect the current application as more and more payors became supported. Each of these requests to generate a claim in the format required by the payor required a new release of the software. These challenges pushed Brightree to find an automated solution that accommodated the EDI claims submission requirements of the DMERCs and provided a more timely solution to payor specific edits.

The Brightree Solution
Brightree made the decision to replace their manual system with the partnered Bostech and Radley solution, ChainBuilder-EDI. Brightree now has the capacity to produce, verify and automate all of the processes related to EDI. With the provided EDI Mapper, Brightree has the flexibility to produce a standard EDI document with verification. Brightree can optionally add or change information that is required for a specific carrier, without the need to hard code the solution. Claims start from the Brightree application through a web service and claim generation is placed in an EDI Scheduler for immediate transmission. Upon completion, status is returned to Brightree along with any relevant reports for that transmission. Data movement is scheduled for every customer with automatic reports available to the Brightree customer.

While the flow and reporting of data was a significant improvement, the ChainBuilder EDI solution also resolved the two key criteria for selecting the product: the ability to handle specific insurance carrier's specifications in a mapping situation rather than hard coding and the automation of the DMERC's dial-up async access.

"Brightree is a progressive medical claims processing software company. We are known in the industry for aggressively leveraging technology to speed and automate business processes" comments Brightree's IT Manager, Mike Durnwald, "The solution has helped us meet our EDI goals by removing all of the manual processes from our eCommerce processing. It has allowed us to standardize our processes and produce faster claims, and in turn, helped us better meet the needs of our clients."

The Partnered ChainBuilder-EDI Solution for B2B Processing

The Bostech/Radley ChainBuilder-EDI solution is a standards-based B2B platform that provides the reliability, availability, and performance required to connect your business to your customers, suppliers, and partners. The solution makes it easy to deploy, manage, and implement application-to-application integration and other B2B business processes. Graphical user interfaces simplify ease of use with intuitive navigation. Job scheduling allows for unattended processing and user definable processes.

ChainBuilder-EDI supports traditional and emerging EDI standards (including EDIFACT, ASC X12, ODETTE, VDA, XML, and subsets), the dynamic requirements networks (including internet, VANs, protocol connections, user defined communication), extensive communication protocols (including ftp/s, http/s, bisync, AS2 and point-to-point) to create a progressive B2B solution for clients.

The five supported areas of the ChainBuilder EDI solution are the Mapper, Scheduler, Document Journal and processing of Purchase Order and Shipping requests.

The EDI Mapper facilitates point and click translation of incoming and outgoing EDI messages via a graphical user interface to map data from source format to target format. The Mapper includes predefined EDI standard documents that can be used as the basis for trading partner specific mapping requirements making mapping even easier.

The EDI Scheduler controls the automation and execution of user-defined jobs for unattended processing, reducing dependence on manual user interventions. Built-in email alert mechanisms send processing logs and audit trails to users when jobs complete, that includes exception-based event processing with configurable re-try attempts.

The Document Journal generates human readable reports matching inbound/outbound documents to originating outbound/inbound documents based on the control numbers contained in the EDI data file. The journal can reprocess or resend any data stored in any archived document.

Purchase Order Processing is an important component of any business. While EDI automates the receipt of purchase orders, the reliable and accurate processing of those orders is critical to the success of your organization. The EDI solution stores purchase order information, any changes and acknowledgments and eventually converts the purchase order information directly into an invoice.

To streamline and verify the Shipping Process is the last yet critical step business documents take to get your products to your customers. ChainBuilder-EDI will populate customer's shipment transactions, generate labels, and maintain and send shipment notices.