Services Provided for Over 25 Years
Healthcare IT Solutions for Health Plan Organizations
DARWHI Consulting delivers specialized expertise across the full spectrum of health plan technology — from initial software selection through go-live and beyond. Deep, hands-on experience with QNXT, Plexis QuantumChoice, HealthEdge Health Rules Payer, Amisys, and related platforms.
Service Areas
What DARWHI Delivers
Health Plan Software Implementation
End-to-end implementation management for health plan core systems including enrollment, claims, benefits administration, and care management platforms. Darryl brings deep experience coordinating vendor teams, configuring business rules, and managing the complex interdependencies that define successful health plan software deployments.
Capabilities
- Requirements gathering and gap analysis
- Vendor coordination and project management
- Business rules configuration and testing
- User acceptance testing (UAT) facilitation
- Go-live support and post-implementation optimization
Systems Migration
Structured, risk-managed migration strategies that move your health plan operations from legacy platforms to modern systems — without disrupting member services or claims processing. Every migration is planned with rigorous cutover strategies and rollback contingencies.
Capabilities
- Legacy system assessment and migration planning
- Cutover strategy and risk mitigation
- Parallel processing and validation
- Operational continuity planning
- Post-migration stabilization support
Data Conversion
Precise, validated data conversion services for health plan member, eligibility, claims, provider, and benefits data. Every conversion engagement includes comprehensive mapping documentation, transformation logic development, and multi-round reconciliation to ensure data integrity from day one.
Capabilities
- Source-to-target data mapping and documentation
- Transformation logic development and testing
- Member, eligibility, and claims data conversion
- Multi-round reconciliation and validation
- Audit trail and conversion reporting
Systems Integration
Seamless integration between health plan core systems, clearinghouses, pharmacy benefit managers, care management platforms, and third-party vendors. DARWHI designs and implements integration architectures that eliminate manual data entry, reduce errors, and enable real-time information exchange across your ecosystem.
Capabilities
- EDI and HL7 integration design (X12 834/837/270/271/276/277)
- Clearinghouse and PBM connectivity
- Real-time eligibility and claims interfaces
- Third-party vendor integration
- Integration testing and monitoring
Technical Depth
Platform & Technical Expertise
Deep, hands-on experience with the leading health plan core administration systems, EDI standards, and integration technologies — not surface-level familiarity, but full-lifecycle delivery.
QNXT
Full-lifecycle implementations, data conversions, EDI gateway, custom integrations, and benefits/provider configuration
Plexis QuantumChoice
Multi-plan implementations, data conversion, EDI (X12 834/837/270/271/276/277), and custom interface development
HealthEdge Health Rules Payer
ConnectorServices integrations for enrollment, provider, and claims; benefits configuration and testing
Amisys / Health Access
Legacy platform migrations, data extraction, and cutover planning
EDI Standards
X12 834 (enrollment), 837 (claims), 270/271 (eligibility), 276/277 (claim status) — design, testing, and production support
SSIS / ETL & C#/.NET
Custom ETL pipelines, SSIS packages, and C#/.NET interface development for health plan data environments
Proven Delivery
Selected Engagements
A representative sample of the complex, high-stakes projects DARWHI Consulting has delivered for health plan clients.
Multi-State I-SNP Migration & Implementation
Led migration and full implementation of Plexis QuantumChoice for eight health plans across multiple states, including data conversion, EDI gateway configuration, and go-live support for Institutional Special Needs Plan populations.
Large Medicaid QNXT Implementation
Senior technical leadership for a large-scale Medicaid managed care QNXT implementation, encompassing ETL development, EDI gateway setup, custom C#/.NET integrations, and benefits/provider configuration.
HealthEdge ConnectorServices Integration
Designed and delivered HealthEdge Health Rules Payer ConnectorServices integrations for enrollment, provider, and claims data flows, enabling real-time exchange between the core system and third-party vendors.
Medicare Advantage Data Conversion
Managed end-to-end data conversion for a Medicare Advantage plan transitioning to a new core administration system — including member, eligibility, claims history, and benefits data with multi-round reconciliation and CMS compliance validation.
D-SNP / Dual Eligible Systems Integration
Architected and implemented EDI and custom interface solutions for a Dual Eligible Special Needs Plan, coordinating Medicare and Medicaid data flows across clearinghouses, state agencies, and the health plan core system.
Have a project in mind?
Let's discuss your health plan technology challenges and how DARWHI Consulting can help.