• Background: An S&P 500 health benefit organization that serves the healthcare needs of more than 15 million medical members and approximately 46 million specialty members nationwide
• Challenge: Increases in identity theft prompted legislation to forbid the use of Social Security numbers as the member identification on all insurance correspondence, which required instituting a new method to create member identification numbers
• Solution: Implement Initiate software to support the transition from Social Security numbers to unique identifiers for both existing and new members
• Results: More than 55 million records from multiple legacy systems were converted to unique identifiers in just five days, avoiding delays in member communications and claims processing

When California Senate Bill 168 was passed, forbidding the use of a Social Security number to identify an individual on correspondence, a leading health benefit company faced a formidable challenge: it had to devise new, unique identifiers instead of Social Security numbers for all new and existing members of its healthcare network.

Compliance with the new California law was broken into various requirements spread over several years with specific deadlines for completion. Each deadline affected different pieces of the organization’s business.

The first deadline was to stop using Social Security numbers by July 1, 2002. This affected the health benefit company as both an employer and healthcare provider. At that time, all the company’s employees were identified by Social Security number under their corporate healthcare plan. As an insurance company and payer, their agents and brokers assigned and used members’ Social Security numbers for identification purposes in correspondence and reports. Nevertheless, on July 1, 2002, all new employees and new healthcare plan members were given a unique identification number – different from their Social Security number.

The second major deadline for compliance was just 18 months later. All records of existing members and identification cards issued prior to July 1, 2002, had to be changed and replaced with a new, unique identifier by January 1, 2004. Consequently, 55 million member records required modification — a huge project that could result in very costly and time-consuming alterations to the organization’s IT system, which includes six legacy systems and more than 50 underlying applications across the organization and the country.

In both situations, the organization achieved compliance with the California legislation and achieved compliance well before the deadline.

Initiate software converts 55 million records in just five days

Seven vendors went through an exhaustive review before the organization selected Initiate software to convert member ID data. According to the director of the medical management system, Initiate Systems was selected due to the software’s proven ability to scale to the millions of records that needed to be managed.

Quovadx, Inc. was responsible for implementing Initiate  software to facilitate the replacement of the Social Security numbers in the existing records. The implementation took just over six months to complete — culminating with the ID conversion for all records occurring at the same time.

Software from Initiate seamlessly integrated multiple legacy systems to achieve on-time compliance. More than 55 million records were converted to unique identifiers in just five days, avoiding delays in member communications and claims processing. More than 15 million medical members covered by the organization’s plans now receive correspondence without dependence on a Social Security number as the member identifier. The six legacy systems containing more than 50 business-critical applications now rely on searching, matching and linking member data across the enterprise using Initiate software. In addition, the organization was internally recognized for the success of this mission-critical project. In a company-wide first, the project was selected out of 750 initiatives as the first-ever project team to win the organization’s Chairman’s Award, which has historically been given to an individual. The team achieved such success by training approximately 8,400 employees to use the new system.

Despite the magnitude of the project, it was really a seamless implementation and conversion. One of the organization’s vice presidents said, “You know it’s a successful project when nobody even knew it happened.” The only visible change to the employees was the new ID numbers on their screens. Adding to this seamless implementation was the easy integration of Initiate software with six legacy systems. Through Initiate  software and extensive data analysis, the organization was able to perform remediation of all its records on six different membership systems. The team resolved the duplicates that the remediation uncovered, and now can readily maintain data integrity with Initiate software going forward.

Now, each member has a unique identifier that can be linked to an enterprise ID, created and assigned by Initiate software. As such, all existing information on each member in a legacy system is linked to and associated with the new unique identifier so past data is not lost or mistakenly associated with another member.

As this leading healthcare management organization grows in the future, Initiate software provides a scalable, service-oriented architecture to manage hundreds of millions of member records. The software employs a unique data model that does not require enterprise-level standardization of data, which, in turn, reduces data ownership challenges that often arise. Software from Initiate also has a unique multi-entity capability that supports the simultaneous management of identities for different types of objects such as plan member, providers and other entities.

Award-winning results

On-time compliance with California Senate Bill 168 was the first and major benefit of implementing Initiate software, which is now deployed across all of the company’s national offices. Other key benefits include:

• Improved customer service by relieving member concerns regarding the use of Social Security numbers for identification
• Improved market position to attract and retain members requiring a health plan with stringent identification privacy policies
• Reduce spending overall on regulatory compliance issues

The extensive integration with the organization’s six legacy systems, which house approximately 50 business-critical applications such as finance, claims, membership, customer service and more will deliver future cost savings and customer service benefits.

Achieving compliance with the legislation was the primary reason for choosing Initiate software and Quovadx implementation services. The next step for the organization is to consolidate its data warehouse and begin to take advantage of the full functionality Initiate software has to offer, including getting a complete view of a member across all of their systems. The company plans to use this trusted system of record for business intelligence and analytics, such as detecting fraud and evaluating high-dollar claims, as well as other analysis.