Tetrasoft Inc.

Our Applications

Our teams at Tetrasoft are academically competent and call upon a broad range of practical experience gained within the IT industry. Committed towards the highest quality standards, our constant endeavor is to provide an exclusive range of IT solutions that are developed to suit our client's requirements and specifications.

Applications that add to our credit are:

Inter Plan Teleprocessing Systems (ITS) as it is popularly known in the US healthcare industry, as a concept began in 1985. ITS is the standard set of electronic formats, standard edits and databases that support claims, inquiries, membership, provider data and financial information.

It consists of a common language, data formats, software, and procedures that allow healthcare plans to access, send receive and control claims information. It allows healthcare plans to communicate information on out-of-area services and provider payments. It also supports the Blue Card Program and enables the members to obtain out-of-area health care services, receive discounts and access to providers.

This application was developed on the mainframes and Tetrasoft supports any new enhancements, maintenance and production support.

National Accounts Service Company or NASCO receives the eligibility data for a well known health insurance company providing services for a specific state. It contains several subsystems like billing, enrollment, claims processing etc.

Enrollment involves adding of new customers to the company and confirming their membership based on the qualifications. Claims processing involves processing of claims filed by the customers, who availed their services either in in-network or Out of network hospitals.

The purpose of this project is to send membership eligibility files from different accounts to NASCO. This project converts the received eligibility files from different sources in different formats to a proprietary format, creates combined file, converts the file to step format and sends the eligibility file to NASCO. These files are full eligibility files. It covers the activities needed for supporting the application for which the customer owns the code and the development and target environments.

In claims processing, specific files will be received from different sub systems and are processed.

The NASCO set of applications were developed on the mainframes and Tetrasoft supports any new enhancements, maintenance and production support on those applications.

The purpose of the Enterprise HEDIS project is to create a strategic solution (data, application and web) across the enterprise for annual HEDIS NCQA/Medical Record Review processes for accreditation. This will include historical capture of measures and metrics to enable trending and analysis across multiple HEDIS cycles to be performed. This data is also expected to be leveraged for other quality initiatives by providing a grain of data that allows analysts to drill to a detailed level if needed. Upon implementation of this project for all HEDIS reporting areas legacy or regional solutions will be retired.

This application was developed on the data warehousing technologies and Tetrasoft supports any new enhancements, maintenance and production support.

The Product Profitability Reporting (PPR) system project was formed in 1988.

The concept of the PPR system includes two major components: PPR Accounting and Data Warehouse efforts. The data warehouse brings together many varied formats of transaction data into one consistent format which is reconciled to financial data, and is balanced from the transaction system to the warehouse.

The PPR Accounting effort identifies revenue and claims cost using a product matrix. This matrix includes SBU, Rating Line of Business, Risk, Fee Arrangement, Product, Network, Reinsurer, and Renewability.

Business decisions were made at the client place to move all reporting (internal and external) from current sources to the data warehouse. The data warehouse is the single source of data for this purpose.

The PPR is a data warehouse, on-line and reporting database. It contains both current, snapshot and historical data. The PPR project has different feeds in the form of Daily, Weekly and Monthly and contains tables loaded in different subject areas like as below:

  • Claims Databases
  • Corporate Decode
  • Group Databases
  • Income Databases
  • Provider Databases
  • Policyholder/Participant/Member Databases
  • Summary Databases

This application was developed on the mainframes and data warehousing technologies and Tetrasoft effectively manages the maintenance and production support.

West Enterprise Data Warehouse (WEDW) holds the data related to different subject areas such as Membership, Claims, Capitation and Revenue. Data for these subject areas will be loaded into WEDW both weekly and monthly.

The main purpose of the application is to provide consistent data from all the subject areas to business users, so that they can use this data to make intelligent decisions in their business.

The data related to different subject areas is processed through mainframe systems to generate source files for WEDW. These source files are generated at WEDW Mainframes end by extracting the data from IMS databases, DB2 tables and table bases. These files are FTPed to UNIX server from WEDW Mainframes and then initially loaded into PDS (Persistent data storage) tables in DB2. Data from the staging tables will be transformed using the ETL logic as per the business requirement and loaded to dimension and fact tables. Views created on these tables will be provided to the business users.

This application was developed on the data warehousing technologies and Tetrasoft supports any new enhancements, maintenance and production support.

Cost Utilization Reporting System (CURS) is an Actuarial system that 'rolls up' Paid Claims into Final Dispositions, Visits, Events, and Admissions. CURS extracts claims data from the Product Profitability Reporting (PPR) warehouse and applies additional edits and corrections. Additional data elements defined by Actuarial are also added to the claims. Subscriber, Group and Provider information is also added to the claims record. This allows further categorization for utilization reporting.

CURS is a database build by grouping and categorization of claims and enrollment data into systematic set of measurements in order to evaluate the cost and usage of medical services. It has Monthly, Quarterly and Yearly jobs. It allows reporting the data at the final disposition, visit, event and admission levels and generally reporting is done on yearly, quarterly or monthly data. It contains both claims and membership data after completion of every month end process.

This application was developed on the mainframes and data warehousing technologies and Tetrasoft effectively manages the maintenance and production support.

Customer Information System (CIS) is designed to give Underwriters, Health Data Analysts and Group Administrators access to timely group specific utilization information. It provides the tools and a common consistent platform as the source of data to meet customer reporting needs. It also provides management type reports and the ability for Underwriters and Health Data Analysts to perform extensive ad-hoc reporting. In addition, as part of the monthly production reporting, a couple of Cost Ratio reports and an Enrollment Shifts report are produced.

The system consists of the below main functions:

  • CIS External: It is designed to provide Group Administrators with summarized, de-identified claims utilization and enrollment data and the tools to easily analyze and report on that data.
  • Underwriting and Customer Reporting System (UCRS): It provides Underwriters and Health Data Analysts with the information and tools they need to perform group renewal, annual and quarterly reporting. Renewal data is used to project pricing for all 100+ accounts.

This application was developed on the data warehousing, business Intelligence technologies and Tetrasoft effectively manages the maintenance and production support.