A leading California health plan, serving a member base of approximately 3.4 million, was aiming to streamline relations with members and providers with a system-wide claims administration and platform upgrade. For this technology modernization effort, the client was looking for a BPO partner to provide efficient acquisition of claims administration skills along with a carefully coordinated ramp-down of claims and administrative activities on the legacy systems.
The HGS core knowledge transfer team conducted a seamless, fast ramp at the client’s training site, while technology teams from both sides worked to develop a speedy transition plan, which maintained the rigid network standards required for a secure, HIPAA-compliant process. From our Bangalore site, HGS assisted with migration of Commercial, Medicare Advantage, ITS, Medicaid, and ASO claims.
HGS collaborated with the client to support a claims migration plan that increased quality of claims management, for optimal data integrity with error-free, agile migration with absolutely no service interruption. Our flexible, skilled staffing provided simultaneous data entry during transition from legacy to Facets®.
HGS immediately got to work assigning and stretching resources to address concurrent updating of the client’s multiple systems. One challenge was the client’s irregular inventory, with uneven distribution across multiple queues. HGS quickly turned this challenge into opportunity, by including cross-skilling to address queues. Our enhanced capability and training ensure professional and standardized training within six months, with 80% of our team cross trained across 60 queues, including: Research and Recovery, XC Claims, and Coordination of Benefits.
Within the five-year migration period, all claims were transitioned to Facets, including a complete migration and claims history. HGS initially provided data entry and also edit resolution, with a day one focus on the legacy system. After exceeding client expectations, our partner expanded our agreement to also provide Facets system support, as well. Our detailed procedures and practices have enabled the client to monitor and manage even the most complex claims. Comprehensive conversion methodologies were applied to ensure data integrity and concurrency with an error-free, hassle-free migration. A total of 80,632 work hours were invested to support migration, with 500,018 ad hoc claims supported.