Nearly half its claims had no pricing trail.
A health plan audited its production systems end to end for the first time. One pass found risks no single team could see.
Challenge
The questions
- 01What is running in production, and what is still in use?
- 02Can every adjudicated claim be traced to the pricing rule behind it?
- 03Where could an upstream gap break a downstream feed without anyone noticing?
Pricing, eligibility, and claims adjudication ran on infrastructure no one had ever inspected end to end.
A manual audit of 4 databases and 705 tables would have taken DBA, data engineering, and analytics teams months. Even then, nothing promised it would be complete.
Each system looked healthy on its own. The risks showed only when findings from different areas were connected, and no team could see more than one area.
Solution
Flume profiled all 705 tables and 91,000 columns across the 4 databases, then ran the audit in 7 phases.
ContextBase connected the findings across areas, so it showed where one gap compounds another. With no reconciliation in place, for example, an upstream error could flow into partner files unseen.
The audit ended in a plan, not a list: 23 actions in 4 tiers. It starts by isolating immediate financial risk. Then come monitoring and reconciliation within 30 days, governance and cleanup within 90 days, and recommendations for the architecture.
Each finding is ranked by severity, tied to its upstream cause, and scoped with a next step.
Impact
$59.3M
Claims with no traceable pricing rule
41.6% of adjudicated claims. The rate audit trail was missing for nearly half the volume.
51
Findings in one pass
Across 7 audit phases, 4 databases, and 705 tables.
69%
Of tables never accessed
487 inactive tables across 4 databases, still using production resources.
<1 day
For the full audit
With an embedded Flume team and governed production access already in place.
- All 51 findings surfaced in one pass, across financial risk, operations, tech debt, and governance.
- A provider tier pipeline for one network had been broken for more than 2 months. Its staging data refreshed daily and was never promoted.
- Partner files for more than 15 downstream consumers had no reconciliation, so a failure would have been silent.
- No single team had seen more than one of these areas before.
Start with the question your team keeps waiting on.
See how ContextBase answers it on your own claims, eligibility, and contract data.