PilotFish Case Studies – How Our Software & Strategies Defeat Every Healthcare Integration Challenge

Healthcare Integration is hard. Nevertheless, we’ve been able to solve every integration challenge with an unparalleled track record of successful implementations. PilotFish has helped leading clients across the healthcare ecosystem implement pragmatic, modern integration strategies and achieve interoperability fast.

With PilotFish, companies have surmounted the challenges of HL7 Interfaces and X12 EDI integrations, legacy systems, problematic EHR integrations, broken processes, proliferating standards, new technologies, limited resources, and more.

Browse through our case studies to view in detail how we have helped a representative set of organizations solve their integration challenges to improve patient care, implement systems faster and improve revenues. You’ll see how the flexibility that we have architected into our integration engine solutions allows us to adapt to any environment and requirement and to changing industry data standards. It also enabled us to leverage new technologies to provide opportunities for greater operational efficiencies, gains in productivity and better system performance.

PilotFish Middleware is being leveraged throughout the healthcare ecosystem – by payers, providers, equipment vendors, cloud services, exchanges and other entities that need to deliver “interop-capable” solutions. Using a simple, graphical Automated Interface Assembly Line, you connect anything to anything – including legacy and new technology that have been developed using different data models, designs or architecture. The PilotFish eiPlatform is compatible with all major databases, operating systems, data formats and communication protocols.

We invite you to let us prove we can do the same for your organization.

Streamlined Billing and Data Integration

PilotFish played a pivotal role in improving the operational efficiency of a nonprofit serving over 40,000 individuals by providing the integration layer for transitioning to the NextGen billing system. The client overcame significant manual data entry and insurance verification challenges by automating these processes. The integration of HL7 interfaces configured by PilotFish facilitated seamless data exchanges, minimizing errors and reducing administrative overhead. The implementation was followed by comprehensive training ensuring that the nonprofit’s team could independently manage the new system. HL7, Claims Validation >

Faster Claims Processing

PilotFish dramatically improved a client’s healthcare claims processing and payment remittances system by implementing their Integration Engine Solution suite. This system, which handles X12 EDI 835 and 837 transactions, boosted data handling, parsing, validation, and usability. As a result, processing times were cut from 14 hours to just 45 minutes—an improvement of over 1000%. This transformation not only increased operational efficiency but also created new revenue opportunities and expansion possibilities. EDI 835, EDI 837, Claims Processing, Payment Remittances >

Healthcare Financial Analytics

Accurate real-time data is critical to successful healthcare financial analytics and operational decision making. In this case study, discover how PilotFish was the game-changer that powered real-time data integration. Automatic data reconciliation and auditing were ensured from data ingestion to transformation. HL7, Custom Validation, Empowered Financial and Clinical Results >

Enhanced HL7 Healthcare Delivery

PilotFish’s HL7 integration solution, proven to be interoperable in any HIE ecosystem, allowed this leading Healthcare company to leverage automation and incorporate customer-specific rules for advanced validation. PilotFish’s built-in flexibility made meeting their business requirements and making changes far easier and faster. Plus, its support for HL7 interface reuse further fast-tracked their implementations. HL7 Automation, HL7 Workflow, Customized Validation, Data Mapping >

Easy Migration from Sunsetted EDI Claims System

Deep expertise in EDI claims processing averted a crisis for this HMO and delivered fast, easy migration from a sunsetted EDI system. New compliance capacity arrived with PilotFish’s unique EDI SNIP Validation Processor. In this case study, discover how partnering with PilotFish modernized the payer’s EDI claims processing system and compliance infrastructure. EDI 837, EDI 835, SNIP Types 1-7, Compliance, Claims Management >

EDI Workers’ Comp Claims System

Robust, modern EDI Integration Solution replaced current sunsetted EDI integration system end-to-end. The company gained advanced SNIP validation of types 1-7 with superior accuracy, efficiency, and scalability. Faster cost-effective closure of workers’ comp claims improved profit margins. See how top EDI technology and EDI expertise delivered. EDI Workers’ Comp Claims System >

Healthcare Data Integration

Payers, providers and service partners struggle to navigate the disparate processes, standards and systems required to integrate social care, behavioral health care and medical care. Learn how a transformative leader moved forward to tame complexity and ensure seamless data interoperability. HL7 FHIR, X12 EDI, Care Delivery, Claims >

Healthcare Claims Accuracy Solution and Payment Integrity

Extensible software, a forward-thinking approach, and the ability to run billions of claims across policies, networks and markets from one platform deliver lower costs and higher quality for healthcare payers. Learn about this new hybrid, cloud-based central platform aiming at all aspects of payment integrity – claims accuracy, eligibility and verification, prior authorization, pricing and plan optimization, and more. HL7 FHIR and X12 EDI Integration > Core Capability for Claims Accuracy >

X12 EDI Specialty Health Insurance Integration

A leading organization that provides health services was experiencing rapid growth and planning to double its size over the next five years. Enhancing its data integration solution was critical to growth projections, improved efficiencies, and reduction of potential risks to its high-volume information processing capabilities. PilotFish provided the client with a cost-effective product replacement path and enhancement of its current solution.

The PilotFish Assembly Line approach ensured that going forward each interface was configured in the same way and updated easily. Leveraging PilotFish’s integration solution with its specialized X12 EDI features ensured robust data integration and accurate validation critical to achieving its goals.  Benefit Management Solution: EDI 271, 837, 834 Integration and more >

EHR HL7 Medical Device Integration

This medical device portfolio of products requires a robust HL7 interface and data integration architecture for nearly real-time EMR integration. Discover how this leading developer of mobile health solutions and remote cardiac monitoring services leveraged PilotFish Integration Solutions to support the development of disruptive monitoring technologies. See the advantages of this customizable and configurable platform in delivering seamless reporting and services. HL7 FHIR EMR HIS ORU >

Quality Analytics

Under new contracts as a Hospital Quality Improvement Contractor (HQIC-CMS), the firm targeted quality improvement assistance to hospitals in response to the opioid epidemic and patient safety. Rapidly integrating HL7 feeds of EMR data from Epic, Cerner and others from over 30 hospitals to meet tight deadlines was the first requirement. The second was finding a cost-effective integration solution that would fall within their existing contract parameters. HL7, FHIR, API Integration >

Hospital HL7 ORU Integration

Lab result alerts from this hospital’s LIS were a persistent pain point for providers. Alerts were so frequent that they were unmanageable, veering on becoming meaningless. PilotFish’s HL7 Interface Engine was leveraged to solve this immediate HL7 ORU challenge. The partnership with PilotFish also positioned the lab for further CPOE implementations. See how PilotFish, the lab and IT architected a single report solution.  HL7 ORU Alerts, Hospital LIS and CPOE >

Healthcare Revenue Recovery Solution

 “A chain is only as strong as its weakest link” applies to X12 EDI data integration and delivering revenue recovery solutions. This company’s processes using advanced data science tools got bogged down by a weak link – EDI data intake. Their home-grown parser just couldn’t handle ingesting millions of EDI 835 and EDI 837 transactions. PilotFish’s eiConsole for X12 and its built-in EDI parser surpassed the client’s home-grown parser across every metric. The big winners in this PilotFish-led revenue recovery automation process were the client’s hospital system customers. EDI 835, EDI 837 and Revenue Cycle Management (RCM) >

EDI 834 and 837 Claims Integration

This full-service third-party benefits administrator is a leader in the self-funded employer benefit health and wellness plan space. The company provides employers with strategic benefits plan design, cost-effective benefits administration as well as reporting and analytic services. With PilotFish as a partner, they have been able to capitalize on plan, utilization and claims data to help their customers balance and control the costs of providing benefits. In this case study, discover how PilotFish’s Integration Engine solution and deep expertise in EDI healthcare data exchange helped them modernize their IT capabilities and reduce costs. EDI 834 and 837 Claims Integration >

NCPDP Integration Solution

TPAs leverage NCPDP standards for information exchange to process and administer employee healthcare and pharmacy benefits and claims. In order to manage and drive down healthcare costs, employers turn to TPAs to create and administer employee benefits plans. Learn how this leading TPA implemented the PilotFish Integration Solution to automate and standardize processes vital to meeting their client demands and their own aggressive growth targets. NCPDP Integration Solution >

COVID-19 Reporting Integration

PilotFish helped this state’s Department of Public Health meet the challenges of quality reporting of an enormous amount of COVID-19 surveillance data to the Centers for Disease Control and Prevention (CDC). Critical data normalization, validation and standardization was performed speedily on incoming data from hundreds of systems and, in turn, was transformed and reported out to the CDC’s numerous receiving systems. HL7 COVID-19 Data Reporting: Benefits of Infinite Flexibility and Extensibility >

Claims Processing in Real-Time

Innovative technology, as well as extensive implementation and integration experience, delivered a winning solution to meet a client’s demanding pharmacy benefit delivery requirements. Learn how this organization, that offers claim processing services, was able to leverage these services and technology to reduce its implementation times by 75% – from 16 weeks to just 4 weeks. Claims Processing in Real-Time >

EDI 834 Integration

Strategic use of data and analytics by this leading third-party administrator (TPA) is critical to delivering value and innovation to its growing employer client base seeking new ways to manage rising healthcare costs and improve employee health. See how PilotFish’s Healthcare Integration Solutions and its eiConsole for X12 EDI provide a competitive edge. EDI 834 Integration >

Rapid EMR Integration Advances PCMH Model

Learn how PCMH organizations that must deal with CCDs, other complex XML formats, and highly variable data achieved EMR integrations at record speed with lower cost outlay. All of the potentials of healthcare coordination are made possible by health registries, health information exchanges (HIEs), and electronic health records (EHRs). Leveraging automated processes and attendant productivity, PCMHs can now quickly evaluate and report on care quality and create a unified view of each patient’s health picture. Rapid Integration Advances PCMH Model >

Population Health Integration

Learn how Population Health enabling technologies helped a Community Health Organization to harness population health data from multiple sources to achieve the linked goals of value-based care: improving quality, lowering population health costs and improving patients’ experience of care. Using data of all types – clinical, financial, administrative, claims – is fast becoming one of the highest priorities for efficient and scalable Population Heath efforts. Accelerating Population Health Capabilities >

Clinical Reference Lab Integration

Real-time data integration and ensuring data integrity was critical to the success of a newly-acquired division of a clinical testing laboratory which performs hundreds of thousands of tests every day and deals with massive volumes of data from many disparate systems. Extremely tight timelines, new systems being developed in concert with the implementation of PilotFish and a lack of IT infrastructure from the acquired firm posed a unique set of challenges. The client relied on PilotFish as their preferred partner for the underlying technology along with their outsourced services team to implement the solution. Moving Targets No Longer Test Lab Integration Limits >

Automated Message Testing and Validation

Electronic data exchange between trading partners has become an imperative for commercial organizations and public institutions alike. To remain relevant, cost-competitive or even viable, companies must replace manual processes with automated solutions. For larger entities, in particular, the digitization of business-to-business communication entails the planning, development, testing, and deployment of point-to-point connections with dozens of, in some cases thousands of, discrete trading partners. This backlog of time-consuming interface work creates a resource strain and expense that challenges even the most well-staffed and well-funded information technology teams. In this case, the study learned how PilotFish has dramatically reduced the man hours, calendar days and budget hours required to successfully onboard electronic trading partners using the innovative eiTestBed framework. Ending Painful Trading Partner Implementations >

Solution Provider Integration with EHRs

Message delivery is critical when impacting patients and serving tens of thousands of meals daily in acute care settings across the USA. Reliably reaching the right patient at the right time and patient safety are paramount. Real-time integration with HL7-based EHRs and admissions, discharges, transfers and order changes is crucial. Learn how a leading food services provider found a real partner in PilotFish to ensure that implementation of its new cloud-based food and nutrition management system was pain-free to its client base and provided a lasting foundation for growth. High-Volume, Complex HL7-EHR Integrations Now “No Problem” >

Medical Equipment EHR Integration Solution

The healthcare division of one of the world’s leading manufacturers delivers new out-of-the-box interoperability capability. By partnering with PilotFish, a single consistent integration approach across product lines was achieved to support a growing client base of globally-dispersed automated medication management environments. HL7 Integration Speedily Incorporated Across Global Platforms >

Data Analytics Integration in Hospital Reporting

High performance delivered! With dominant position and market share in hospitals and practices throughout the United States, the client is focused on delivering a single source provider of financial, operational and quality metrics, coupled with proprietary, value-added analytical services. This massive big data integration challenge, a tough bake-off, and implementation proves the superiority of PilotFish Integration Engine Solutions. Delivering Higher-Quality Analytics in Less Time
with Less Staff >

HIE and Claims Clearinghouse Integration

Legacy system hangover, stressed resources and impatient customers are a cry for moving to a modern architecture and integration solution. Learn how a Healthcare Claims Clearinghouse and HIE challenged its new integration solution to re-engineer and transition its claims processing architecture in record time with no disruption to existing connections or increase in resources. A small internal team armed with the new tools and PilotFish support met every challenge. With newfound agility, the organization has responded efficiently to growth and increased transaction volumes. Lean, Lightweight Healthcare Integration Leverage at Work >

Lab Data Large-Scale Integration

A subsidiary of one of North America’s largest labs is on the verge of being buried under a mountain of requests for interoperability from healthcare providers, insurance providers and government entities. Learn how they partnered with PilotFish to rearchitect their approach to data transformation and transmissions to reach peak integration capability. Implementation Timelines Slashed Enabling Revenue Growth >

Revenue Cycle Management Solutions

The client is a well-established clinical laboratory billing and collection company serving companies nationwide. The organization offers cloud-based solutions which enable their client laboratories to maximize profitability through optimization of the revenue cycle and reimbursement process. The client has had (and continues to enjoy) significant commercial interest in its services. However, many of its critical business processes remained manual. This intense requirement on human resources threatened to put a cap on their growth, due to an inability to keep up with demand. Read on to learn how the client leveraged PilotFish to initiate automation. Achieving Claim Entry and Processing,
End-to-End, in 7 minutes >

State Agency Enterprise Integration

Struggling to recover from an economic downturn and a political climate that required state governments to do more with less, one of the nation’s 50 states found itself challenged to keep pace with the demands of its information infrastructure. In an example of what a successful public/private partnership looks like, the state collaborates with PilotFish to change the state’s paradigm for integrating systems. Unified Architecture Leveraging Federated Model and Reuse Speeds Implementations >

HL7 is the registered trademark of Health Level Seven International.
X12, chartered by the American National Standards Institute for more than 35 years, develops and maintains EDI standards and XML schemas.