Domain Expertise

Healthcare

HEDIS quality measures, EDI X12 processing, CMS interoperability, and payer analytics — delivered across 80+ US healthcare clients and data from major payers including Aetna, Anthem, and Blue Cross Blue Shield.

Healthcare · Quality Measures

HEDIS Quality Measures Engine

Built calculation logic for HEDIS quality measures such as Breast Cancer Screening (BCS), Cervical Cancer Screening (CCS), and Colorectal Cancer Screening (COL) — covering eligible populations, denominators, numerators, and exclusions across payer claims and enrollment data.

HEDISNCQABCS / CCS / COLValue SetsICD-10 / CPT / HCPCS+3 more

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Healthcare · EDI & Standards

EDI X12 File Processing

Built parsers and pipelines for X12 EDI transaction sets — 834 enrollment, 820 premium payments, 837 claims, and more — converting loop/segment structures into clean, analytics-ready tables.

834/820/837core X12 transaction sets parsed

7+file formats standardized (EDI, HL7, XML, Parquet, CSV, JSON, Excel)

EDI X12834 / 820 / 837835 RemittanceHL7XML / JSON / CSV+3 more

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Healthcare · Interoperability

Interoperability & Data Standardization

Data standardization and standard data model (SAM) development for interoperability programs — including requirements and gap analysis of existing payer data against the CMS-9115-F and CMS-0057-F interoperability rules.

CMS-9115-FCMS-0057-FFHIRStandard Data Models (SAM)Gap Analysis+3 more

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Healthcare · Analytics

Payer Analytics & Reporting

Built the analytics and reporting layer used by US health plans: member months, care-gap reports, insurance leakage, IBNR reserves, claims and provider reporting, provider performance, and high-cost member analyses.

80+US healthcare clients served

8report families delivered

Aetna · Anthem · BCBSmajor payer data experience

Member MonthsPMPMIBNRCare GapsLeakage Analysis+3 more

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More projects coming soon