Transax is a leading provider of information network solutions for healthcare providers and health insurance companies. Through the development and operation of its MedLink Solution, Transax connects HMOs with their service providers (doctors, clinics, hospitals, etc.) to facilitate transactions for eligibility checks, referrals, payments, claim adjudication, etc. This real time automation decreases costs to both the provider and the insurer while improving service to the patient. The elimination of paper-based transactions helps eradicate fraud, a common problem in Brazil, and dramatically reduce the time needed to complete health care claims and authorizations.

Currently, three large clients, two pilot sites and one live, in Brazil use MedLink for transaction processing. The volume is as high as 200,000 transactions per month though the system is ready for up to 3 million. Brazil has roughly 35 million transactions per month with only 5% taking place on-line. The market is ready for a product like MedLink to take over. With offices in California, Brazil, Singapore and Australia, Transax plans to bring MedLink to the rest of the world as well.

Datatek, a software company, developed MedLink for TDS (Telecommunications Data Systems), the company responsible for operating the electronic transactions network in Rio de Janeiro, Brazil.

Visit Summary

While Transax is headquartered in California, the class visited the technology center at TDS in Rio de Janeiro. TDS staff presented their product, technical requirements and work environment. The offices were very open with lots of windows promoting a team effort. The developers are also highly committed to this new product with many working late into the evening.

TDS explained MedLink as simple transaction processing with several ways to capture data and transport it to the network processor for real-time authorization. The capture methods include POS terminal, phone, PC, server and Internet. The health care provider can select which method best suits its needs and technological abilities to create a seamless transaction. Server is the most common capture method with 50% while telephone and POS share the other 50%.

MedLink is powered by Mosaic Softwares Postilion software, a platform for web-enabled ATM/kiosk applications, electronic funds transfer switching, point of sale, pre-pay, and mobile commerce transaction processing. Postilion acts as the Network Processor and routes the transactions captured to the Authorization System of the health care plan using telephone lines or the Internet with uninterrupted service. TDS has completed a lot of Java Customization for this processor as well. There is much translation code written to pass data to the network processor then send it on for authorization. The Authorization Systems software is composed of a control module and a group of Stored Procedures that validate the specific rules of the health plan or insurer. Much code is written to receive, identify, validate, and update the data as well as apply business rules for administrative, technical and historical analysis of the data.

TDS tries to maintain a small, close development team but often the amount of programming is too much. Along with the coding of the network processor and authorization system, the server component of data capture is huge. It was fully developed in Java using Microsoft J++, which required their in-house programmers to learn new skills. This led to some problems with maintenance and downtime while performing upgrades, but they are working through it. They tried outsourcing some of the development work, especially the web portion, but it did not work out very well for them. Now they try to keep enough dedicated developers on staff to complete the work themselves.

When asked why some of the technology was so outdated for new software ventures in 2004 (like heavy emphasis on X.25 and telephone lines), TDS said they are forced to work with what is available in Brazil. Most health care providers do not have Internet access or even a computer and most patient files are paper-based. Brazil has just recently developed a widely distributed, stable telephone infrastructure, but it will take much longer for Internet connectivity to be widespread. In addition, Internet protocols are difficult to negotiate and involve a large investment in time. Essentially, they had to work within the current limitations of the infrastructure in Brazil.

Related Links

http://www.transax.com