Claims System Replacement

Claims system replacement projects are costly and complex. There are many opportunities to make mistakes that change the course of the project. To ensure success you need the right team.

Healthcare Frontier’s experienced team and proven implementation methodology provide what you need to avoid costly missteps and achieve a timely go live.  Our approach ensures a claims system that meets your business requirements and that is maintainable post live.

We’ve been implementing claims systems for over thirty years and our implementation approach reflects our deep experience and lessons learned.  Having implemented over seventy claims systems worldwide for startups to million+ member plans, we know what works.

Implementation Strategy

We strategize with you on topics such as whether to adopt a phased implementation approach; whether to license optional modules; which implementation tasks are good candidates for outsourcing, etc.

Project Management

We can lead your claims system replacement project and/or provide PM support.  We can perform project oversight and vendor management.  We apply PMBOK™ principles and ensure all knowledge areas and process groups are represented in our work.

Data Conversion

We deliver successful data conversions by simplifying the process and by following a structured approach.  We work with you to determine conversion selection criteria, mapping and cross-walks, translation logic, and tasks that need to be performed post conversion if needed.  We develop audit tools to validate conversion results.

Configuration

We work with your staff to intelligently configure your new claims system.  We apply naming conventions and coding standards to ensure consistency; we develop configuration prototypes to validate configuration approach.  We make a deliberate effort to configure with long term maintenance in mind.

Design and Development

Most claims replacement projects include systems integration work, enhancements/customizations, and report development.  Healthcare Frontier has a long history of performing this type of work with great success. 

Within the lens of claims system replacement projects, here are some examples of common Healthcare Frontier development deliverables:

Enrollment EDI functions

Claims EDI functions

• Encounter Reporting

Access Express (authorization web portal) integration to various claims systems

Claims system integration with EMRs

Testing

We develop test plans and work with you to perform all aspects of testing needed to ensure a successful project.  Our approach is to perform unit testing, functional testing, end to end testing, and user acceptance testing.

Production Readiness Assessment

All of our projects include a component to assess your production readiness.  Healthcare Frontier has developed a systematic approach for assessing the adjudication accuracy of your configured system.  This accuracy measure is then used along with other factors to inform your go live decision.

Go Live Decision

We provide a framework for use by stakeholders to determine whether the system and organization is ready for go live.  The framework provides quantitative measurements of go live factors which are monitored by stakeholders and executive management to validate the go live decision and go live date.

Workflow and process design

Using business process management (BPM) principles, we work with your staff to design, model, execute, monitor, and optimize the processes you’ll need to support your new claims system.

System Selection

When you engage us to spearhead your claims system selection, we work with you to crystalize your project goals, develop a project charter, align stakeholder and board project priorities, develop a budget and obtain budget approval.   We work with you to develop an RFP (request for proposal) and identify claims system candidates.  We then employ a structured approach to evaluate each system against pre-defined criteria to produce a system selection recommendation.