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Conference 35.181::insurance

Title:Insurance Industry Conference
Moderator:ICPSRV::DOVE
Created:Thu Feb 18 1988
Last Modified:Wed Feb 05 1997
Last Successful Update:Fri Jun 06 1997
Number of topics:136
Total number of notes:551

23.0. "Group Life and Health" by DDMAIL::MCDEVITT (Everybody out to the field!) Mon Mar 21 1988 23:51

    This note is for recording everything you know about - or need to
    know about - Group L & H Administration and Claims. There are many
    players in this field, but not many yet on DEC platforms.
    
    I would ask that if you find out about a particular solution, please
    let us know if it is a truly distributed solution, or simply a
    downsized mainframe solution.
    
    Note that this is not just a "solutions" note. It is also a problems
    note, a "win" note, a point for discussion note, a clarification
    note.
    
    Ed McDevitt
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23.1Health Claims SoftwareNCVAX1::WALSHThu May 05 1988 13:1249
    
    The following software came to my attention from a software search
    done by Principal Financial Group for use in their group claims
    offices around the country.
    
    The GMIS clinical infomation system is used to develop medical coding
    based on terminology a doctor would submit with a claim. One example
    of this is conversion of a diagnosis into ICD9-CM diagnosis codes.
    This product has some expert system features, and a database which
    is updatable by the user. It is programmed in MUMPS, and runs on
    VAXes, PC's and on IBM Mainframes under MVS/CICS.
    
    There are two VAX versions, one which uses online menus, the other
    which runs as a background task and returns codes to a data entry
    program (via mailboxes). The later version is used by a current
    Digital customer, although I'm not sure which one.
    
    GMIS is also coming out with a Claims experience auditing product
    which is "leading edge" in terms of analyzing claim payment and
    utilization. This is currently being piloted under CICS, but could
    be ported to the VAX if some Digital people out there could find
    a market for it.
    
    The context for the product in the VAX environment may be either
    in conjunction with an existing VAX-based claims system (background
    or online), or (as my customer may use it) as a distributed application
    accessed from the mainframe (either using asynchronus adapter in
    3174 controller or through SNA Gateway) via APPC or through terminal
    emulation. This product may also be a great application for Blues
    plans, as coding and medical terminology is of importance to them
    in their business as well (the claims auditing product may even
    be more important than the coding product).
    
    The address is:
    
    GMIS, Inc.
    5 Country View Rd.
    Suite #110
    Malvern, PA 19355
    (215)296-3838
    
    Contact: James Walsh, National Sales Manager
    
    By the way, to my knowledge, this vendor is not listed in SOFTBASE
    or in the Software Source Book. (At least I didn't find it.)
    
    Regards,
    
    Terry Walsh
23.2ACES, Anyone?BMT::MENDESFree Lunches For SaleMon Jul 04 1988 18:4217
    Prior to coming to Digital, I worked for Noble Lowndes, International.
    They had previously acquired Woodward, Ryan, Sharp & Davis. They
    marketed a package called ACES- Automated Claims Entry System. It
    was written in COBOL and some BAL, and ran under CICS using VSAM
    files. It was "portable", i.e., there were MVS and DOS/VSE versions
    which were very similar to each other.
    
    The systems and services division of NLI was acquired by Erisco,
    a subsidiary of Dun & Bradstreet. ACES is no longer marketed. Erisco
    offers a number of products, including one called CLAIMFACS which
    competed directly with ACES.
    
    If anyone is interested, I'd be prepared to continue this discussion.
    For openers, contact me offline at SUBWAY::MENDES or RICHARD MENDES
    @NYO. (DTN 352-2556).
    
    - Richard
23.3Looking for VAX front-end systemsAUNTB::KNIGHTLIWed Feb 22 1989 14:178
    Does anyone have a customer running a payroll deduction system on
    a VAX.  Jefferson Pilot wants to build a "front-end" to their mainframe
    processing systems that are policy based.  This front end will be
    a relational data base that is client based and will allow payroll
    deduction billing, collection and reporting for all kinds of insurance.
    They have part of the system built in dBASE and will port it to
    a VAX.  These customers want to talk to someone who is using DEC
    in this way.  Thanks.