EvolveWare Named in the Inaugural Gartner® Magic Quadrant™ for AI-Augmented Code Modernization Tools. Learn More
EvolveWare Named in the Inaugural Gartner® Magic Quadrant™ for AI-Augmented Code Modernization Tools. Learn More
EvolveWare’s Intellisys platform and services were used to extract the business rules from a state’s Medicaid claims system in 6 months. This work was done to identify what key policies were running in the current system, determine if any of these policies were missing from the modern off-the-shelf system and add them as needed. The project was completed without needing to freeze the source system code and within the initial timeline despite scope changes. It enabled the state to move forward with the transition to the modern system.
State Government
Agile Business Rules Extraction
Generated documentation for and extracted business rules from 1.3MM lines of COBOL code in 6 months
The Story
Since the advent of Medicaid in 1965, state governments have served as repositories for sensitive health information of their constituents in order to provide low-income families access to affordable healthcare. As the years passed, health departments began to face the costs of having this information stored in legacy systems that operate on old and outdated technologies. Moreover, these systems required constant maintenance related to evolving regulatory conditions and general upkeep. This problem was exacerbated in 2010 when the Affordable Care Act passed which expanded the eligibility conditions for Medicaid and led to even more information being stored in these systems.
In an effort to solve this problem, many states have contracted with private companies that have developed modern Medicaid systems. Moving to an “off-the-shelf” system allows these states to process claims at a faster rate, offer a more user-friendly interface that they don’t have to maintain, and save on burgeoning legacy costs. When another state decided to move off of their legacy platform and adopt an off-the-shelf Medicaid system, the system provider determined they needed a way of understanding what policies were in the current system in order to identify if all the relevant policies were already included in their system or if some needed to be imported in. In order to do this, this system provider contacted EvolveWare to see if the Intellisys platform could help automate this process for this state’s Medicaid claims system, while ensuring that no policies were left out.
Challenges
Dwindling Support for Legacy Languages
The state’s claims system was written in COBOL. The talent pool available to support this technology is rapidly shrinking as newer talent are not well versed in these languages and technologies. Therefore, developing an understanding of the current logic was important but a challenge to do with current resources.
Lack of Documentation of the Current Medicaid Claims System
There was no current documentation of the system that could serve as a foundation to determine what policies were currently running. This posed a problem for transitioning to the modern platform as the state needed to ensure that all relevant policies from the original system were implemented in the new system.
Complexity and Size of Project
The original system consisted of 1.3 million lines of code which were broken down into a total of 183 programs comprising 15 modules. Each module required a generation of a full set of documentation artifacts including flowcharts and decision tables, renaming of cryptic variables, curation/annotation of rules, and the generation of a summary document that contained all the rules in a manner understandable to technical and non-technical personnel. Doing this work manually for over a million lines of code is not only expensive and time-consuming but highly prone to errors, introducing risk into the project.
Changes to the Code Base during the Project
As maintenance was performed on the current claims system during the project, these changes needed to be accounted for in the new version of the system. The project team needed a way to see code changes and the impact on their modernization work while modernizing so as not to lose sight of these changes when moving to the new platform.
Solution
Provide documentation artifacts such as flowgraphs and decision tables for the entire Medicaid claims system to help with understanding of the system.
Automate the consolidation of business logic to identify and extract business rules in a readable language so that the system provider could compare rules from the state agency legacy system to the new system.
Update the source code repository and generate reports showing changes made to the original system and the impact they may have on modernization work performed so that the state did not need to freeze their code.
Create a phased approach to the project with intermediate deliverables by separating the project into modules. This helped make the project more manageable and provided opportunity for correction along the way.
Results
ADSO
ASP
Assembler
C/C++
CL/DCL/ECL/JCL
C#.Net
COBOL
Cold Fusion
EasyTrieve
Forte
Fortran
