Workflow-driven portal solution for Case Managers, Providers and TPA’s Coordinators

  • Provided a consistent User Experience to Case Managers, Providers and TPA’s Coordinator.
  • Provided insight to the stakeholders into the process, save valuable time and costs by minimizing process inefficiencies, and introduced evidence based care plans.

Business Situation

Our client, a health payer affiliated Third Party Administrator (TPA) recognized an oncoming shift in how all its stakeholders, case managers, providers and the TPA’s coordinators could improve their efficiencies and effectiveness.

The client sought a workflow based portal that would provide all stakeholders valuable insights into the process, improve outcomes by using templates for evidence based treatment plans and save healthcare claims costs. The solution was targeted as a paradigm shift to provide the TPA a competitive advantage.


The various stakeholders, Case managers of Insurance Carriers, Providers and the TPA’s coordinators did not have a unified view into the treatment process.

This was accentuated with inconsistencies in scheduling appointments, selection of providers, use of evidence based treatment plans and insights into the treatment process.

The TPA sought a workflow based solution for internal & external case managers, providers and the TPA’s monitors to adhere to consistent processes for the desired outcomes.


ValueMomentum assisted the TPA with architecture, design, development and deployment of the solution using Oracle 11g suite, which includes WebCenter, SOA Suite and Application Grid Suite. The solution addressed:

  • Workers Compensation and Personal Injury Protection.
  • Major treatment plans that were assessed as high impact on claims frequency and severity.
  • 15 Sub processes.
  • Case Managers, TPA’s Monitors, TPA’s Program Coordinators and Providers.