In the past few years xScion has performed over 125,000 hours of Consulting Services at Healthcare companies in the DC region. This experience has allowed us to build a team of subject matter experts as well as an extended network of valuable resources who have the latest industry and technology knowledge. Below is a small sample of some of the work we have performed.
Claims Enhancement/Claims Pre-Adjudication Project: The mission was to re-architect a large, Cobol mainframe claims processing system with a much more flexible and powerful Java J2EE component based SOA application to perform automated claims pre-adjudication (which determines how a claim will be processed and which rules will be applied) for a nationwide system. With visibility up to the CEO, the success of this complex conversion was critical to demonstrate that the company had the ability and the will to move a highly visible, complex application to a leading edge environment and to retire the existing legacy application. The legacy application was also tightly integrated with many other applications and these applications had varying degrees of documentation. Working swiftly and productively with other groups and systems, the project overcame numerous obstacles with bold and innovative solutions including replacing an expensive, inflexible 3rd party rules based engine product and building their own superior tool; expanding the project scope when necessary if other groups upon whom they had dependencies couldn’t move forward and
thereby solving other groups problems as well as their own; and setting up their own testing tools and methodology. Despite the challenges, the system was delivered on time and is now in production.
xScion Duties: Involved from the inception through project delivery, xScion provided two out of three of the Technical Leads as well as Technical Architecture expertise, Database expertise, Senior Developers, the Test Team Lead, and Testers. The Tech Leads performed technical architecture, led teams of Senior Java Developers, and performed hands-on development. They were responsible for the design and development of key modules in the system, including message flow, application of rules, and conducting code reviews. They worked directly with departments throughout the company to obtain critical information and to ensure the programming staff had the resources needed to complete tasks on schedule. Developer tasks included performing system analysis and design, producing various UML artifacts, development, integration with in-house and third party modules, design and development of a JMS based service bus for integration with heterogenous systems, development of classes for XML parsing and transformation using SDO and XMLBeans, development of a POJO based persistence layer using Open JPA, and developing custom Admin UI components and screens. The Test Team Lead was responsible for planning, coordinatiing and overseeing the testing activities of various work stream testing teams consisting of more than 30 staff members. Duties included developing a program level test plan that formed the framework for the work stream level test plans. The plans included system, integration, end to end, and user acceptance testing as well as involvement in parallel testing (to
compare the output of the legacy system and the new SOA system) and performance testing. The technical environment was JDK1.6, JMS, JAX-WS (REST/SOAP), Apache Axis, Spring, Struts, Open JPA, JSP, Servlets, Junit, Oracle, TOAD, ANT, RAD, MQ & Websphere, SOATest, Quality Center
Member Profile and Benefit Information Tool (MPBIT): The objective of the MPBIT project is to design and maintain a web based application to provide medical insurance companies with 1) benefit scripts with tailored Member specific information relative to the Member’s out-of-pocket expenses (e.g., deductibles, co-pays, catastrophic maximums, etc.) and 2) indicators identifying the Member’s disease state and participation or lack of participation in the company’s wellness and disease management programs. This application will be accessed via the enrollment system and will support the enhanced and expanded role of Customer Service Representatives (CSRs) by providing them with a tool that provides information to allow them to promote wellness programs, direct Members to care management programs and provide consistent and accurate benefit information. The application will be a benefits scripting tool that will interface with the enrollment application to provide Member specific out-of-pocket expenses and maximums relative to the benefit script as well as the data warehouse to obtain Member specific data relative to the Member’s care management experiences.
xScion Duties: xScion provided key personnel, as permanent hires and as consultants, in almost every leadership position on this strategic project. The Manager of Business Architecture and the Java Tech Lead are permanent employees hired by xScion for our client. xScion consultants include the Project Manager, Senior Business Architect and Requirements Analyst (as the main contact with the client), Business/Requirements Analysts, and Senior Java Developers.
EOB Online and Targeted Messaging: Explanation of Benefits (EOB) enables members (policy holders) to receive benefit statements online which is faster and more efficient than receiving it by US mail. The online statements can be viewed, saved, and printed. The Online Targeted Messaging functionality enables the insurance provider to send customized, targeted health tips and reminders to members based on the member’s specific health conditions with the goal of encouraging healthy behavior, improving prescription drug compliance, and reducing medical costs.
xScion Duties: Responsibilities include Business Analysis and Development of the application. This includes gathering requirements, defining complex business rules that will support millions of healthcare consumers, creating Use Case scenarios and diagrams as well as functional requirement specifications, activity and process diagrams, and data dictionaries. Additional duties include defining the Requirements Traceability Matrix, ROI, acceptance criteria, and risk factors; acting as liaison between external customer, business owners, subject matter experts, stakeholders, and technology resources for development of new solutions and ongoing maintenance of existing solutions. Also performed technical architecture, design and development as well as coding, code review, and unit testing in a Java J2EE, ORM, Spring, Struts, ORM environment.
De-identification of Personal Health Information (PHI) in Software Testing Environments: Our customer is continuously seeking ways to reduce its risk of HIPAA violation by targeting the use of and access to PHI data in its systems. The purpose of this project is to terminate the use of PHI data in its software testing environments. The project started with a Data Masking solution designed to quickly and efficiently de-identify PHI data in all internal testing environments. After a thorough cleansing of the existing mainframe environments, data from the production environment is downloaded and masked 4 times a year to provide a fresh suite of test cases in a central testing data store. The data store can then feed any testing environments as needed. Data masking is also coordinated with the need of external partners such as data warehousers. The second phase of the project involves a migration to fully automated testing based on entirely synthetic data. Using the HP Quality Center tool, business requirements are entered and associated with one or more test cases. Each test case is attached to values stored in an SQL database that are assembled into an X12 transaction to be tested on the system. This provides our client with a comprehensive, repeatable and predictable testing process that will increase the overall quality of the service provided to the 39 independent health care operators it supports.
xScion Duties: Actively participate in the research, design, architecture and implementation of the project. Provided experienced resources in business analysis, information technology design and tool selection, automated testing engineering, testing and masking tools configuration, as well as overall technical project management. Technical Environment: IBM Mainframe, DB2 Database, CICS, Cobol, FileAid, Expeditor, X12, XML, HP Quality Center , QTP, FileAid EX, SQL Server, Visual Basic
xScion Project Methodology xScion's Consulting Triangle Sample Engagements Project Management Project Team Organization Application Development Data Analysis Business Analysis Management Consulting Project-Based Initiatives Permanent Placement 
