Ending the Patient Eligibility Inquiry Bottleneck

nGeniusONE: Ending the Patient Eligibility
Inquiry Bottleneck


  • nGenuisONE rapidly pinpoints root cause of patient eligibility inquiry application slowdowns
  • Identified issue as a connection between firewalls in a cluster that impacted bandwidth availability
  • Once reconfigured, inquiry delays were quickly resolved
  • Eliminated war room “finger pointing”
  • Ensured SLA compliance, reduced risk of penalties
A century-old healthcare insurance provider with roots in the Northwest U.S. serves millions of members across multiple states, providing preventative care, as well as treatment of health-impacting conditions.

The Challenge: Network Slowdowns Effect Eligibility Inquiries, Impacting Patient Care

While the maxim “first, do no harm” may have been intended primarily for doctors, its guiding principle clearly applies to IT as well, as they serve a critical role in supporting the healthcare system. As Guardians of the Connected World™, IT is responsible for ensuring the highest quality of network and application performance.

For this U.S.-based healthcare insurance provider, significant network slowdowns were adversely impacting application services used by providers for 270/271 patient eligibility inquiries. As a result of these slowdowns, doctors and hospitals were unable to determine in a timely manner whether or not prescribed treatments were covered by insurance. In addition to impacting patient care, these delays also put the insurer at risk for service level agreement (SLA) violations. IT was faced with the challenge of identifying the root cause of network slowdowns in order to rapidly triage and improve mean time to repair (MTTR).

The Solution: nGeniusONE Pinpoints Root Cause of Network Issues

In order to tackle its network and application issues, the insurer’s IT team worked with long-term technology partner, NETSCOUT™, to pinpoint the root cause of infrastructure slowdowns. The nGeniusONE™ Service Assurance platform with Adaptive Service Intelligence™ (ASI) technology and InfiniStream® appliances offer critical traffic-based intelligence into service performance across primary and secondary data center locations, as well as at a new co-location that is currently being brought online.

Using nGeniusONE, IT staff has been able to gain visibility into the overall payer environment, from the Internet connection and firewalls to the application servers to the databases and storage. This allows IT to triage and troubleshoot issues impacting communications from doctors and hospitals requesting patient treatment approvals and service privileges. NETSCOUT’s holistic analysis saves time in pinpointing the root cause of problems, thus ending war room “finger pointing.”

Value: Real-time Intelligence Ensures SLA Compliance

When network slowdowns occurred, negatively impacting patient eligibility inquiries, IT staff was forced to look at firewall logs, searching for a needle in a haystack to identify the source of the problem. Now, using nGeniusONE with ASI technology to provide critical insights, IT is able to rapidly identify the cause of problems in real time. For this insurer, the problem turned out to be a connection between the firewalls in a cluster. Recent changes to the data center firewall impacted bandwidth availability in those connections, resulting in a service slowdown.

nGeniusONE allows IT to monitor the network, providing real-time analysis for daily reporting to the groups responsible for supporting these vital systems. As a result, IT is able to:
  • Quickly pinpoint root cause of network slowdown
  • End war room finger pointing
  • Reduce MTTR which results in improved patient care
  • Ensure SLA compliance, avoiding non-compliance penalties
The overall success of the nGeniusONE implementation has led the organization to expand its use of the solution, focusing on unified communications (UC) and Exchange services.