Healthcare Management System Modernization: Automating Member Records and Insurance Mapping

Industry

Healthcare

Project Type

SaaS / Web App

Services

Custom Software Development

Duration

Multi-year

Technology

.NET, ASP.NET Core, React, Azure, AWS

01

Project Overview

A healthcare services client was running a healthcare management system responsible for maintaining health and insurance records, but the system had fallen out of step with what the client needed. Member data went out of date, refreshes lagged behind, and patient-insurance mapping wasn’t reliably accurate. Much of the upkeep depended on people doing it by hand, which led to errors and operational inefficiency, making it harder to keep records accurate.

SiGa Systems was engaged to modernize the system: refactoring the legacy .NET codebase, rebuilding the frontend in React, and building the automated data workflows needed to keep member and insurance records current without relying on manual upkeep. The engagement has continued as an ongoing effort since November 2023.

02

Key Results

Improved Data Integrity

Automation and stricter validation reduced manual errors in healthcare and insurance records.

Consistently Updated Records

Healthcare and insurance data stayed current instead of drifting out of date.

Increased Reliability and Performance

Modernization work improved how dependably and efficiently the system ran.

A More Maintainable Platform

Refactored legacy code and a modernized frontend left a more maintainable foundation for ongoing work.

03

The Challenge

Outdated Member Data

Member data fell out of date, making it harder to maintain accurate and current records.

Delayed Data Refresh

Refreshing active datasets wasn’t happening fast enough, leaving healthcare and insurance records outdated.

Inaccurate Insurance Mapping

Patient-insurance mapping wasn’t reliably accurate, a problem tied directly to insurance-related operations.

Manual Processes and Operational Inefficiency

Much of the upkeep depended on people doing it by hand. That led to errors and operational inefficiency, making it harder to keep records accurate.

04

Our Approach

Monitoring and Diagnostics

Technology Modernization and Refactoring

SiGa refactored the legacy .NET codebase and upgraded NuGet packages, incorporating resiliency features as part of that upgrade.

Technology Modernization and Refactoring

Monitoring and Diagnostics

Health checks were implemented across backend services, alongside enhanced logging for proactive performance tracking and faster issue resolution.

Automated Data Workflows

Automated Data Workflows

Workflows were streamlined to auto-terminate outdated records and refresh active datasets, replacing manual upkeep with automated processing.

Data Validation and Insurance Mapping

Data Validation and Insurance Mapping

Backend validation and workflow logic were enforced to keep insurance linking accurate and records reliable and consistent.

Frontend Modernization

Frontend Modernization

The frontend was modernized with React, replacing the system’s prior interface with a modern, responsive one.

05

How the System Works

Healthcare / insurance data

01

Member and insurance data enters the system.

Data validation

02

Backend services validate healthcare and insurance records.

Record processing

03

Records are processed according to that validated logic.

Data refresh

04

Active member datasets are refreshed, and outdated records are automatically terminated.

Insurance mapping

05

Patient-insurance mapping is applied to the processed records.

Monitoring

06

Health checks and enhanced logging track the system’s performance throughout.

06

Key Features

Automated Member Record Management

Workflows automatically terminate outdated records and refresh active datasets, replacing manual updates with an automated process.

Insurance Plan Mapping

Automated workflow logic supports accurate patient-insurance mapping, addressing what had been a documented source of inaccuracy.

Application Health Monitoring

Real-time health monitoring with automated checks gives the team ongoing visibility into backend service performance.

Resiliency and Retry Logic

Retry logic and fault-tolerance mechanisms were introduced to improve system resilience.

Modern React-Based Interface

The frontend was rebuilt with React into a modern, responsive interface.

Enhanced Logging and Diagnostics

Enhanced logging supports proactive performance tracking and faster issue resolution, working alongside the platform’s health checks.

07

Technical Challenge

Modernizing a Tightly Coupled .NET System

NuGet compatibility issues and the legacy architecture’s tight coupling made refactoring the existing .NET codebase more complex than a straightforward upgrade.

Modernizing Without Disrupting Active Operations

The system supported critical healthcare services, so modernization had to be carried out without disrupting the operations already depending on it.

08

Technology Stack

Backend

.NET Framework

ASP.NET Core

C#

Web API

RESTful Services

Entity Framework Core

Frontend

React.js

HTML5

CSS

Bootstrap

JavaScript

jQuery

Messaging

RabbitMQ (Message Broker)

Amazon SQS

Caching

Redis

MemoryCache

HIPAA Compliance

Database

Microsoft SQL Server

Testing / API Tools

Swagger

SOAP UI

xUnit Test

Postman

DevOps / Cloud

Azure DevOps

GitHub Actions

Azure App Services

Azure Functions

Azure Storage

AWS ElastiCache

AWS

Task Management

Azure Boards

Microsoft Teams

09

Results & Impact

Improved Data Integrity

Automation and validation reduced manual errors across healthcare and insurance records.

Consistently Updated Records

Automated workflows keep member and insurance records more consistently up to date.

Improved System Reliability

Health checks, logging, and resiliency features improved system reliability and performance.

Reduced Manual Effort

Automated record management reduced the manual work required to maintain healthcare and insurance data.

More Maintainable Platform

Legacy modernization and the React frontend created a more maintainable foundation for ongoing development.

10

Conclusion

The healthcare management system had fallen behind on keeping member and insurance data current, relying on manual processes that introduced errors and slowed operations. SiGa modernized the system’s legacy .NET backend and React frontend, replacing manual upkeep with automated record management, data validation, and insurance mapping, supported by monitoring and resiliency work. The result is a more reliable system with more consistent healthcare and insurance records and less manual effort required for routine record management.

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