Unified Health Platform Cuts Admin Costs by 40% For Healthcare Payer

THE CLIENT

A leading healthcare technology provider.

BUSINESS CHALLENGE

The client was operating on three disparate legacy claims platforms—GIS, HEALTHpac, and QicLink—to support different lines of business. This fragmentation created operational inefficiencies, duplicate processes, higher administrative costs, and challenges in ensuring regulatory compliance. The client wanted a unified platform to tackle the following challenges:

High manual effort due to limited EDI automation, low auto-adjudication (100% manual COB claims), and numerous manual processes.
Fragmented operations caused by multiple systems, segmented customer service teams, and lack of CRM integration.
Poor insights and compliance due to lack of enterprise-level reporting/analytics, data inconsistencies, and regulatory exposure.

THE SOLUTION

The client partnered with Mphasis to transition all claims administration functions onto the Mphasis Javelina® platform. The migration strategy included:

Comprehensive assessment of the existing GIS, HEALTHpac, and QicLink environments.
Data mapping and consolidation into a unified Mphasis Javelina® framework.
Process harmonization across claims intake, adjudication, enrollment, and billing.
Phased migration to ensure business continuity while minimizing risk.
Automation of compliance checks and regulatory reporting.
Enhanced customer service through integrated CRM and single-view access.

BUSINESS BENEFITS

Single source of truth with all claims operations consolidated on Mphasis Javelina®.

40% reduction in administrative overhead by eliminating redundant processes.

35% improvement in auto-adjudication rates, reducing manual interventions.

Regulatory alignment with HIPAA, CMS, and ICD-10 compliance built into workflows.

Enterprise-level reporting & analytics enabling better decision-making.

Scalable foundation to support future growth and value-based care initiatives.