Towards an integrated and healthy tomorrow

The PPACA (Patient Protection and Affordable Care Act) has redefined the healthcare landscape with lasting changes being wrought on all key stakeholders of the healthcare ecosystem. The landscape continues to evolve as various constituents of the ecosystem grapple with understanding/deriving the maximum value from the convergence of technology, process and business model redesign of the healthcare ecosystem. Organizations will necessarily have to move the conversation beyond the silos of their industry to having a dialogue from the perspective of a rapidly evolving constantly changing group of key stakeholder groups that have minimum expectations around information relevancy, latency and delivery buttressed by real and stark expectations around product efficacy, individual eco system optimization and ultimately meaningful health outcomes.

Healthcare’s primary customers are increasingly digital natives– they continue to gather and source information from a number of curated and un curated information channels. The influence of buying decisions from such sourced information continues to increase and evolve. New ways of engagement and technologies including wearables, social media, M2M integration ,e PRO, Quantified Self etc have forced healthcare organizations around the world to rethink how they will and can continue to engage with myraid stakeholders (patients to practitioners) as well as stakeholder organizations(pharmaceuticals, hospitals, payers, GPOs, Medical Devices etc). The Sales and Customer approach has undergone a transformational change with new insights required/driven from increasingly limited access to decision makers, glolocalization strategies, stakeholder segment micro stratification strategies, virtual agents, social media and mobility. Business Analytics to keep the competitive edge in the market has moved multiple generations from standard reporting to predictive modeling and stochastic optimization.

Our Services and Solutions

We provide innovative IT services and solutions to healthcare organizations worldwide that help them set new standards in efficiency by:

  • Leveraging cutting edge technologies and frameworks to drive Ubiquitous Personalization of the organization’s key constituents.
  • Enabling optimal healthcare delivery through our custom cloud solutions as well as allowing zero latency in business decisions through customer insights derived via Social media, Mobility, and Analytics.
  • Aligning business processes, systems and supporting mechanisms to transform business
  • Enabling use of electronic records, health information exchange, wireless solutions,M2M integration and other innovations that improve productivity and the quality of care
  • Ensuring payment accuracy while reducing fraud, abuse and waste
  • Providing medical management solutions that improve health outcomes and reduce the total cost of care

Mphasis Healthcare Service offerings


  • Healthcare IT and BPO Services for Several Medicaid State & Local, Blue Cross Blue Shield and Commercial Health Plans: We provide our expertise to Medicaid Carriers, BCBS and Commercial Healthcare service operators in domains such as:

    • Membership Management
    • Benefit Administration
    • Provider Networks and Contracts
    • Claims Adjudication
    • Prior Authorization
    • E-Prescription
    • Portal - Member, Provider, Employers, Brokers
    • Managed Care
    • Premium Billing and Financials
    • EDI
    • Sales Management
    • Care Management
    • Customer Support

  • Expertise for Healthcare mandates and compliances – Mphasis has experience in supporting the customers to meet the following mandates such as:

    • 5010
    • ICD-10
    • Public Exchanges
    • Healthcare reform changes like MLR, Eliminating limits, pre-existing conditions etc.
    • Administrative simplification
    • Blue Card mandates.
  • Providers

  • Healthcare IT services for several Hospitals with the following offerings :

    • Hospital IT assessment and consulting
    • Development and implementation of custom HIMS with modules covering the value chain of provider:

      • Patient Scheduling and Registration
      • Clinical Documentation
      • CPOE
      • EMR/EHR
      • Ancillary modules
      • Billing & Claims
      • Financial
      • Decision support system (DSS)
      • Patient Portal
      • Medical devices integration through various standards like HL7, DICOM etc.
  • Mphasis Integrated Practice offerings for Healthcare:

    • BI & Analytics

      • ACO Analytics Framework: Accountable Care Organizations are going to play a very crucial role in the US Healthcare. To achieve the core objectives of improving care delivery and reducing cost, ACO's need a solid IT foundation supported by advance analytics. Mphasis with its deep healthcare knowledge has developed an analytics framework help organizations avoid cost and improve quality of healthcare.

      • Customer Insights as a Service (CIAAS) : With the current changes brought about by the rapid adoption of confluence of social networking, mobile computing, analytics, and cloud computing (SMAC), the rise of the API economy (Co-Innovation Platform), overall consumerization of IT (CoIT), and most importantly the coming to age of the digital natives, MphasiS has created a consulting framework based on proven “design thinking” principles and methodologies to help our clients select, adopt and operationalize the right set of “next generation” technologies and methodologies. As part of this overarching solution we have our IP Social Media Analytics framework using open source tools drive convergence and analysis of structured and unstructured data from social media,internet and other related internal/external datasources to provide actionable insights to optimize service quality and increase market share.

    • Mobility

      A comprehensive suite of solutions include

      • Member portal app: With growing use of Mobiles, many healthcare payers are moving on to create mobile apps for their members. Mphasis Mobility practice has come up with a mobile app design that allows members to search physician, download ID cards, view claims & benefits, receive active alerts and download health data in Blue Button format and share with doctors over wifi/Bluetooth.

      • Blue Button+ on Mobile: One of the criteria of Meaningful Use Stage 2 – Patient Engagement - is to enable patients to View (V), Download (D) and Transmit (T) health records. The industry recognized Blue Button format will allow the healthcare data holder to meet the V/D/T of Patient Engagement under MU-2. Mphasis Mobility practice has come up with a design thinking driven /user experience optimized Mobile App design that allows users’ to exchange health history records in BlueButton® format between various healthcare entities (Payers, Providers, Labs, Pharmacies, Care givers etc.) and store, view and manage it in offline mode too.

      • Mobility Testing as a service (MTaaS): We cover end to end cycle Development, Functional, Performance & Monitoring automated testing through integration with ALM/QC. The key highlights include the facts that the service is:

        • Platform and device agnostic
        • Modular and reusable framework
        • Available in a variety of service based Models

    • Mainframe

      • MIPS Optimization framework: With the implementations of modernized applications, there is a growing need to contain the IT costs specifically spent on the Mainframe CPU usage in MIPS (unit: millions of instructions per second) on a rationalized basis. With strong expertise in supporting decades old legacy systems for various healthcare entities, Mphasis mainframe team has developed a framework to optimize Mainframe usage costs. Mphasis mainframe practice has developed a framework with the following four phased approach to meet the customer needs:

        • Analysis with tools
        • Propose recommendations
        • Implement Pilot
        • Monitor & Control

    • EDI

      • EDI resource and performance optimization: Mphasis has several years of experience in delivering EDI services through EDI system, EDI environment configuration, EDI testing, L1/L2/L3 support. Mphasis EDI practice has developed and delivered flexi-support models with best practices and automations to achieve the business goals of best on-time EDI performance scoring. The teams use the statistical methods of six-sigma and lean to achieve best quality deliverables and access the optimized resourcing for the client needs.

    Mphasis Products

    • Javelina: Javelina is an open source web-based platform from Eldorado, specifically developed to manage today's claims adjudication and administration imperatives. This solution is flexible and scalable to meet future healthcare-management challenges.

    • HEALTHpac: HEALTHpac is a flexible and powerful healthcare claims administration platform from Eldorado, known for its low-cost ownership and operation as well as proven customer service.

    • MHygea: Our Hospital Management Information System, MHygea, provides a 360 degree view of hospital operations and workflows and enables you to manage the hospital as an enterprise.

    • ICD 10 - iNTELLi 10 Suite: iNTELLi Suite is a comprehensive solution that helps healthcare payers and providers assess the impact of the change on their business and create strategic roadmap for compliance either through complete remediation or through tactical approach. iNTELLi suite comprises of best-in-class tools and frameworks for impact assessment, crosswalk management, ICD testing and payment neutrality analysis.

    Trizetto Facets Services

    • Configuration and Testing Services: Mphasis provides facets configuration and testing services through its highly experienced team of facets analyst. The team has extensive healthcare domain knowledge and Facets product expertise in the areas of benefit configuration, provider agreements, provider networks, claim adjudication, business rules configuration and member services.

    • Integration with Data warehouse: Mphasis has extensive understanding and experience of integrating Trizetto's Facets solution with existing Data warehouse in payer environments.

    HP Products Support

    • MetaVance: A fully integrated, HIPAA-ready administrative application that enables single or multiple insurers, employer groups and managed care organizations to administer HMO, PPO, indemnity and other hybrid managed care programs.

    • HPS: The next generation Healthcare Administration platform by HP, built upon Service Oriented Architecture, recognizes the need for ease of use while utilizing a leveraged set of processing services to support both Commercial and Government Healthcare payers.

    • Atlantes: HP's Atlantes Integrated Care Management System provides healthcare organizations with a comprehensive set of tools to plan and manage cost-effective care for members. The system is highly flexible, enabling case managers to create multiple levels of care and track an unlimited number of diagnoses and procedures for each of these levels.

    • Healthcare Portal: A stand-alone commercial software portal application provides self-service capabilities for healthcare members, providers, employer groups and brokers.

    The Mphasis Advantage

    Our global healthcare experience covers Payers, Providers and ACOs. We take immense pride in being the best-in-class IT innovator providing hyper-specialized, cutting-edge solutions that help address the evolving challenges of today’s healthcare enterprise.

    • End-to-End Integrated Solutions across Application support, Business process outsourcing and Infrastructure services.
    • Extensive experience and knowledge of the Payer and Provider domain areas
    • Worked on all types of healthcare: Medicaid, Medicare, Blues and Commercial Plans
    • Highly experienced in developing and managing Payer and Provider COTS Products, Frameworks, New Projects and Legacy Systems
    • 5 level Healthcare Domain Certification program to train and certify resources