The Department of Health Care Services (DHCS) administers several individual health care service delivery programs, including Medicaid, Children’s Services program, Child Health and Disability Prevention program and Genetically Handicapped Persons Program.

These programs are run by Healthcare legacy rules extraction systems that are undocumented and hence no longer maintainable and need to be modernized so that they can be maintained, scaled, and evolved with changing requirements.

Business Requirement:

  • Federal Govt. has mandated that the State must extract and validate the embedded rules in these legacy systems against the policy manual of each program.
  • The goal would be to transform these rules into modern code or exported into a business rules engine or a process management tool.

This would allow the State to compare the extracted rules with the most current policy manual, thereby allowing only relevant rules to be used in the proposed modernized system.

Our Solution:

  • Nubes Opus can help with tools, technologies and processes that can
    • determine if the current system was meeting the State’s legislative laws
    • validate any target future systems that the State is interested
    • provide a highly automated and accurate business logic
    • provide features to derive business rules from business logic and
    • export the derived rules in the desired format

 Business Benefit:

  • From a value-add standpoint, the solution once completely implemented, not only provides the State with documentation and an understanding of their current system,but also gives them a platform to keep the documentation updated on an on-going basis.

This is a major step forward for the State, considering the large amounts of money being allocated for maintenance of their systems.

  • While the benefits will take some time to be quantified, the hurdle to modernization will been removed as the State can now match the extracted rules to their policy manual and determine which rules will feature in the target system, otherwise the target system would have had to be written from scratch based solely on the policy manual, and this effort would have been very risky and time-consuming considering the size and complexity of such a system.

“From legacy to modernization, from centralized services to open api’s, from manual to automation … nubes opus got you covered”