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newsDatabricks·August 17, 2020

Healthcare Claim Reimbursement using Apache Spark

Description

Optum Inc helps hospitals accurately calculate the claim reimbursement, detect underpayment from the Insurance company. Optum receives millions of claims per day which needs to be evaluated in less than 8 hours and the results need to be sent back to the hospitals for revenue recovery purposes. There is a very low tolerance for delay and error in the claim processing pipeline because it saves millions of dollars in revenue for the hospitals. Most of the US hospitals run at a profit margin of 2%, without accurate claim processing, many hospitals won’t be able to survive. In the past 3 years, we have been replacing an Oracle-based system by one written in Apache Spark, Scala, and Java. In this presentation, we will discuss 1.The conversion of claim ingestion process from PLSQL on Oracle to Apache Spark which improved the performance by 50% and reduced the cost significantly. 2.The design and POC have been done to replace the ‘claim reimbursement’ module from PLSQL to Spark. a.How using Spark opens up our solution space to accommodate both batch and streaming which was not viable with Oracle. Oracle is good for only batch processing with tons of trouble. b.How Spark is helping us wr…

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