MedBank Quickly Integrates Health Insurance Processing in Korea
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MedBank, a leading IT services company based in Seoul, Korea was recently chosen to build and manage an online portal that provides “one-stop shopping” for heathcare users who need to submit insurance claims.
MedBank’s client is the Korean Preferred Provider Organization (KPPO) – created through the sponsorship of the large healthcare organizations and the Korean Hospital Association, which officially represents all hospitals in Korea. The KPPO currently has approximately 300 member hospitals, and serves people throughout Korea. After carefully researching their options for integration technology, MedBank selected InterSystems Ensemble®.
The Private Insurance Claim Intermediary System developed by MedBank acts as a clearinghouse for private insurance claims, collecting them from member hospitals and sending them to the claims systems of the designated insurance companies. It gives people with private health insurance the same convenience enjoyed by those who are members of the public health insurance system – they no longer have to collect documents from their various healthcare providers and file the claim themselves.
“Ensemble lived up to its reputation for rapid integration. We built a complex, and highly secure, connected application in just a few months.”
-Seung-Guk Lee
Vice President
MedBank
Not only does the automated system make life easier for users, it also helps cut down on insurance fraud. And, it will allow insurance companies to develop new offerings, which will serve to expand the private health insurance market.
“We chose Ensemble,” says Mr. Seung-Guk Lee, vice president of MedBank, “partly because it is being used for major, national-level healthcare integration projects in other countries. But even more important than that was the level of technical support InterSystems provided during the proof-ofconcept phase of the project.” The proof-of-concept was performed in May of 2006, and demonstrated Ensemble’s facility with handling HL7 messages, and the power and flexibility of its rules engine.
Based on the results of the proof-of-concept project, Ensemble was officially chosen as the integration platform for the Private Insurance Claim Intermediary System. MedBank’s development team received Ensemble training in June of 2006, and the initial development took place from July through September. In October of 2006, MedBank started deploying and running the system. “Ensemble lived up to its reputation for rapid integration. We built a complex, and highly secure, connected application in just a few months,” says Mr. Lee.
Ready for growth
By 2009, the Private Insurance Claim Intermediary
System will be deployed at 800 member hospitals
and many insurance companies. KPPO expects
approximately 1200 hospitals and 25,000 clinics
will be enrolled by 2012. The system will process
an estimated 15,000,000 claims daily, and will also
handle car, fire, and life insurance claims.
MedBank’s long-term goals include further integration of Korea’s private and public health insurance systems, as well as adapting their successful solutions for use in other countries. “We are targeting the construction and management of a national-level health portal that will benefit all residents of Korea, as well as healthcare providers and all insurance companies,” explains the president of MedBank, Mr. Yong-Nam Park. “We are also looking for partnerships to expand this business model to fit the needs of other Asian countries.”
InterSystems will play an important role in helping MedBank achieve their goals. Says Mr. Lee, “Based on our experience with Ensemble, we plan to maximize our use of InterSystems’ technologies.”