Learn How one Payer Solved its Compliance Challenges

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With team members averaging 15+ years of experience in the healthcare industry, our consultants have worked in a variety of management and I.T. leadership positions within commercial and government payer organizations, so we understand first-hand your challenges—including competitive pressures, organizational obstacles, and limited resources. Our experience includes assisting 100+ health plans in nearly all 50 states on diverse projects that range from complex, multi-year enterprise implementations to concise, efficient assessments or market inquiries.

 

Use-Case

A small, managed-care health plan, located on the West Coast, sought an experienced IT Project Manager to manage a high-profile compliance project to achieve CAQH CORE Phase I, II and III certifications. Not only was this a complex, multi-departmental effort, but there were hefty fines if the tight nine-month deadline was not met. The PMP Certified Change Healthcare Consultant led a cross-functional team in the implementation of new electronic data interchange transactions and testing with the CAQH organization to ultimately achieve the mandated certification.

Following the original implementation, the client continued to supply multiple projects to the Project Manager, keeping her on-staff for over four years. What was originally one project turned into more than ten completed projects. These projects included small and large, multiple projects at a time and varied in scope.

Final Outcomes

All four major projects, and additional smaller projects, were completed with the highest regard for industry project management standards. The largest accomplishment was the successful launch of a new Medicaid member benefit in collaboration with the State. The Change Healthcare Consultant even led local health plan collaboration strategy sessions, an additional project, to develop a regional standard for provider data exchange. From the successful launch of the initial project to the closeout of the final project, the Change Healthcare Project Manager was on-site for over four years, successfully leading over ten projects to completion.

Client Problems

  • Tight timeline and low staff for high profile State-mandated compliance project
  • Demand for a newer, up-to-date cloud-based ITMS application
  • Inadequate provider data management processes and reporting
  • Lacked an experienced IT Project Manager to implement and launch a new Medicaid benefit

Project Results

  • Successfully prevented the Client’s risk of $1.5M fines/per year with an on-time, under budget project delivery
  • Managed the successful implementation of Remedyforce from selection through enterprise roll-out
  • Established a provider network system that delivers data to multiple partners and feeds a real-time web portal
  • Successfully launched a new, coordinated care benefit for Medicaid Members
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