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A leading healthcare payer relied on its Submit Order process to initiate critical workflows like prescription order, claims, and service fulfillment. However, the legacy system had become increasingly rigid, making changes difficult and introducing higher operational risks. Virtusa modernized the system using its Virtusa Helio platform and agentic AI capabilities, automating documentation, extracting business logic, and generating scalable code. The result: faster delivery, lower costs, and a future-ready foundation.
In healthcare, outdated code doesn’t just slow down systems—it can delay care, frustrate providers, and erode patient trust. When foundational processes like order submission are built on legacy code with no clear documentation or flexibility, the consequences cascade: longer wait times, missed authorizations, and rising operational risk. For this payer, the Submit Order workflow had become a silent bottleneck—impacting everything from back-office efficiency to frontline service delivery.
The Submit Order process was central to how the organization initiated service requests, routed them for validation, and triggered fulfilment. But built on an aging PL/SQL codebase, hidden business rules, and no clear documentation, the system was a hurdle to operational agility, regulatory responsiveness, and care continuity.
To modernize, the payer needed more than a rewrite. It required a strategic unearthing of business logic through reverse engineering using genAI, replatforming the workflow into a metadata-driven, microservices-based architecture to enable faster, safer, and more scalable evolution going forward.
That’s when the organization turned to Virtusa to unlock legacy complexity and set the stage for AI-powered automation, API led architecture, and enterprise-grade AI adoption.
To modernize its prescription processing systems without disrupting core operations, the healthcare organization partnered with Virtusa to reimagine its PL/SQL-based architecture. Anchored in the AI-native Virtusa Helio platform, the solution used the Engineer & Automate service layer along with Virtusa Helio App Analyzer to decode and reframe legacy logic for a modular, API-first future.
The team reverse engineered large volumes of embedded logic into structured pseudo code, enabling selective forward engineering of high-impact modules. The resulting design laid the foundation for scalable automation, improved maintainability, and composable services-based workflows.
Implementation began with focused analysis of the legacy PL/SQL codebase using the Virtusa Helio App Analyzer—specifically targeting the complex Submit Order functionality. Key business rules and process logic were extracted and documented, creating visibility into previously opaque workflows.
Pseudo code generation helped deconstruct large, stored procedures into modular components aligned with the Submit Order value chain. These insights drove traceability, reuse, and cost-effective modernization. Each transformation was tightly mapped to business priorities, enabling faster cycle times, reduced operational effort, and a clear path to modernization at scale.
The transformation delivered measurable value across operational efficiency, system agility, and end-user outcomes. Beyond technical gains, the solution created a strong foundation for enterprise-grade AI adoption.
Key outcomes included:
The healthcare organization selected Virtusa for its deep expertise in payer systems, engineering-led modernization, and ability to work seamlessly across legacy and emerging platforms. Virtusa’s Helio platform—featuring App Analyzer, domain-tuned genAI accelerators, and low-code orchestration tools—enabled a modular, insight-driven approach to modernization, minimizing disruption while maximizing reuse. As the initiative advances, Virtusa continues to support the organization through reverse engineering, documentation, and selective forward engineering of the Submit Order capability. Upcoming phases will focus on scaling this framework to additional business processes, streamlining modernization across the value chain, and accelerating time to value.
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