Brandon Sharp

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A web service designed to transmit the user’s answers to the health risk assessment test taken in the Complete Wellness Plus Web Application. The WCF web service transmits the answers to a third-party partner web service who analyzes the test. Results are formulated by the third-party vendor and are then transmitted back to an additional web method that is part of the service.

Features Include:

• Real-time health risk assessment results
• Instant user results and feedback
• Secure transmission of personal data

Technologies Utilized:

• WCF
• C#.NET
• MS SQL Server

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Desktop application designed to be a customer relationship management program. Created to include functionality equivalent to SalesForce.com, ACT, and Sugar CRM. Tracks customer/provider conversations and contact for both sales and recruiting staff.

Features Include:

• Contact management, including relevant phone, email, and address information
• Note capability to track conversations and reminders entered by the user for each contact
• Email attachment capability through a custom Outlook plug-in, allowing users to attach email to a contact for retrieval and review at a later date
• Integration with Prime Health’s Queball application allowing for meetings and follow-up phone calls to be scheduled for the recruiter automatically
• Reporting options for sales statistics and provider recruitment statistics

Technologies Utilized:

• C#.NET
• Oracle
• LINQ to SQL

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Content management system designed for Prime Health Services to allow many custom client websites to be created and managed by account managers without the normal overhead associated with maintaining and updating a commercial website.

Features Include:

• Ability to customize pages with client logos and specific text
• Ability to branch off custom URLs from the main PHS web site
• Custom PPO provider database look-ups tailored to the clients’ specific access levels

Technologies Utilized:

• C#
• MS SQL Server
• Microsoft MVC Framework

A WCF web service designed to receive a “stack” of medical claims through an XML web service transmission. In real time, the medical claim information is processed with network discounts, state regulations, and usual and customary discounts being applied. The best possible PPO provider is selected through an algorithm giving weight to more desirable providers and discounts.  The response is then sent back to the client including the newly adjudicated medical bill.

Features Include:

• Real-time bill adjudication
• Secure data transmission through the web service
• Ease of use provided by the XML format

Technologies Utilized:

• WCF
• C#.NET
• Oracle

Budget:

• $200,000

Project Length:

• Iterative process over 3 years

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Desktop application designed to drive the network development process at Prime Health Services. Accepts provider nominations from various sources including client web submissions, recruiter research, call center research, and targeted data mining. Directs recruiting process by assigning providers to recruiters, scheduling follow-up meetings, and automating mail room processes.

Features Include:

• Automated mailings, faxes, and emails to potential providers, freeing up employee time for other tasks
• Assignment of recruiting leads based on location
• Scheduling of follow-up appointments for recruiters in custom CRM application
• Conversion statistics for each employee showing their recruiting efficiency
• Reports based on average recruiting times, medical specialty information, regional recruiting averages, etc.
• Processes which can be driven by recruiting budget, taking into consideration a maximum amount to be spent each day. The process can slow or speed up based upon that budget.
• Different mailing combinations may be sent out depending on the specific mailing campaign. For example, extra documents may be required in certain states.
• Maximum postage savings through presorting and bar coding mail items based on USPS standards to receive bulk mail rates

Technologies Utilized:

• C#.NET
• Oracle
• LINQ to SQL

Budget:

• $150,000

Project Length:

• 8 months

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A medical bill adjudication software application designed to reprice group health, workers’ compensation, and auto liability medical claims. Allows for EDI, FTP bill drop, web service, and traditional keying of medical claims for entry into the application database. Once bills are entered, state rule methodology is applied in addition to PPO discounts. Finally, an explanation of benefits form is generated to complete the adjudication process.

Features Include:

• Complex state discount logic and rules engine
• Complete bill adjudication and claims tracking application
• EDI/web service support
• Extensive reporting capabilities
• Thin-client access

Technologies Utilized:

• C#
• Oracle
• MS Terminal Services
• ActiveX
• Crystal Reports

Budget:

• $600,000

Project Length:

• 2 years

Various data export utilities designed to take the Prime Health database of providers and export the data into formats specific to each client. Often, clients would have their own proprietary format and PHS would have to give data out to the client in their chosen format.

Features Include:

• Client specific data formats
• Export of data from the database

Technologies Utilized:

• C#.NET
• Oracle

Budget:

• $10,000 per client

Project Length:

• 2-3 months per client

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