CLIENT SUCCESS STORY I MAJOR HEALTH BENEFIT … · Agile Migration to Facets™ Delivers...
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CLIENT SUCCESS STORY I MAJOR HEALTH BENEFIT PROVIDER Agile Migraon to Facets™ Delivers Concurrency and Breakthrough Quality, Accuracy, TAT HGS BEST PRACTICE As further indicaon of our partnership success, the client selected HGS for voice services from our Manila, Philippines locaon. HGS provides process improvements, such as educaon and training via a shared drive integraon with our Manila team. Per the process improvement, HGS stored Bangalore-originated customer service notes on claims correspondence to providers. With this informaon, Manila call center staff members are beer educated and equipped to handle escalated cases. The projected end result will be: • A beer provider experience, with reps more informed and educated on how to handle escalated cases • Improved first call resoluon • Fewer escalaons • Reduced transfer rate • Improved provider educaon to idenfy trends that can improve claims cycle mes Objecve In 2011, a top three California health plan, serving a member base of approximately 3.4 million, was aiming to streamline relaons with members and providers with a system-wide claims administraon and plaorm upgrade. For this technology modernizaon effort, the client was looking for a BPO partner to provide efficient acquision of claims administraon skills along with a carefully coordinated ramp-down of claims and administrave acvies on the legacy systems. Aſter a compeve selecon process, HGS was chosen as a preferred partner, because of our superior rankings in all of the following areas: • Health insurance administraon and claims processing experience • Agile staffing for seamless service and no interrupons • Operaonal efficiency, benchmarking, and strategy • Client relaonships built on transparency, trust, and growth • Flexibility to meet clients’ evolving needs • Willingness to invest and lead the partnership With this decision in place, the client agreed to deploy HGS’s core knowledge transfer team at their training site, while technology teams from both sides worked to develop a speedy transion plan, which maintained the rigid network standards required for a secure, HIPAA-compliant process. From our Bangalore site, HGS assisted with migraon of Commercial, Medicare Advantage, ITS, Medicaid, and ASO claims. Our Soluon HGS collaborated with the client to support a claims migraon plan that increased quality of claims management, for opmal data integrity with error-free, agile migraon with absolutely no service interrupon. Our flexible, skilled staffing provided simultaneous data entry during transion from legacy to Facets TM Within the five-year migraon period, all claims were transioned to Facets, including a complete migraon and claims history. HGS inially provided data entry and also edit resoluon, with a day one focus on the legacy system. Aſter exceeding client expectaons, our partner expanded our agreement to also provide Facets system support, as well. Our detailed, procedures, and pracces 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 migraon. A total of 80,632 work hours were invested to support migraon, with 500,018 ad hoc claims supported. HGS has met 98% or beer for all TAT and SLA requirements and for the more stringent IPP requirement, 95% or beer. The conversion was managed and successfully completed within the five-year me frame. .
Transcript of CLIENT SUCCESS STORY I MAJOR HEALTH BENEFIT … · Agile Migration to Facets™ Delivers...
CLIENT SUCCESS STORY I MAJOR HEALTH BENEFIT PROVIDER
Agile Migration to Facets™ Delivers Concurrency and Breakthrough Quality, Accuracy, TAT
HGS BEST PRACTICEAs further indication of our partnership success, the client selected HGS for voice services from our Manila, Philippines location. HGS provides process improvements, such as education and training via a shared drive integration with our Manila team.
Per the process improvement, HGS stored Bangalore-originated customer service notes on claims correspondence to providers. With this information, Manila call center staff members are better educated and equipped to handle escalated cases. The projected end result will be:
• A better provider experience, with reps more informed and educated on how to handle escalated cases
• Improved first call resolution
• Fewer escalations• Reduced transfer rate• Improved provider education
to identify trends that can improve claims cycle times
ObjectiveIn 2011, a top three 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. After a competitive selection process, HGS was chosen as a preferred partner, because of our superior rankings in all of the following areas:
• Health insurance administration and claims processing experience• Agile staffing for seamless service and no interruptions• Operational efficiency, benchmarking, and strategy• Client relationships built on transparency, trust, and growth• Flexibility to meet clients’ evolving needs • Willingness to invest and lead the partnership
With this decision in place, the client agreed to deploy HGS’s core knowledge transfer team at their 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.
Our SolutionHGS 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 FacetsTM
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.
HGS has met 98% or better for all TAT and SLA requirements and for the more stringent IPP requirement, 95% or better. The conversion was managed and successfully completed within the five-year time frame.
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OutcomesWhen HGS began claims migration, the client was working with an additional BPO provider. At the outset of our project, this other vendor provided 80% of support and HGS provided 20%. As the partnership progressed, the client provided HGS increasing claims responsibilities, so that the service ratio shifted to 80% HGS and 20% other BPO partner. This is the most significant indicator of client satisfaction—HGS’s services expansion as the client’s preferred BPO provider. HGS exceeded quality and TAT SLAs for all migrations, with the procedural SLA met at 99.40% and financial SLA at 99.80%.
Other proof points include:
Production
400800
1,600
2,472 2,547
915
2,514 2,6233,340
4,775
0
1000
2000
3000
4000
5000
6000
Jun-11 Jul-11 Aug-11 Sep-11 Oct-11
Average Daily Production vs. Goal
Beginning at project inception in July 2011, HGS was able to exceed
production goals by factors of as much as 2 or 3, month after month.
Quality
93.86%
98.33%99.21% 99.60%
90%
92%
94%
96%
98%
100%
Jul-11 Aug-11 Sep-11 Oct-11
Monthwise Quality
HGS’s success in consistently exceeding production goals was accompanied by ever-increasing quality results, culminating in a mark of
99.60% after just four months.
Expedience
8 86
22
6 64
16
0
5
10
15
20
25
Train theTrainer
ProcessorCertifications
ParallelRun
ProjectSignoff
Project Implementation Timelines
Goal Actual
Traditionally, multiple-edits knowledge transfer requires 8-10 weeks of client-led training and certification, with similar timelines for claims processing staff. Another 6-8 weeks are typically required for mentored production, before clients can be assured of quality output from an outsourcing partner. For this project, HGS exceeded client expectations, by producing stable results within 16 weeks of implementation. The following chart shows some additional information about HGS’s timeline performance, relative to industry standards in the train-the-trainer, processor-certification, and parallel-run phases of implementation.
Beginning at project inception in July 2011, HGS was able to exceed production goals by factors of as much as of two or three, month after month.
About HGSHGS is a leader in optimizing the customer experience and helping our clients to become more competitive. HGS provides a full suite of business process management (BPM) services from traditional voice contact center services and transformational DigiCX services that are unifying customer engagement to platform-based, back-office services and digital marketing solutions. By applying analytics, automation, and interaction expertise to deliver innovation and thought leadership, HGS increases revenue, improves operating efficiency, and helps retain valuable customers. HGS expertise spans the telecommunications and media, healthcare, insurance, banking, consumer electronics and technology, retail, and consumer packaged goods industries, as well as the public sector. HGS operates on a global landscape with 44,000 employees in 66 worldwide locations delivering localized solutions. For the year ended 31st March 2016, HGS had revenues of US$ 507 million. HGS, part of the multi-billion dollar Hinduja Group, has more than four decades of experience working with some of the world’s most recognized brands. © 2016 HGS
Contact us at:1-888-747-7911
@TeamHGS
www.teamhgs.com
Challenges:• Understanding the complex data structure of a legacy
claims system and migrating to a new Facets claims management system
• Stretching of resources, due to concurrent updating of multiple systems– Rework and service interruptions– Staffing scale
Results:Diligent execution of migration plan, with alignment to all service levels and significant improvements, including:
• Exceeding quality and TAT SLA for all migrations: procedural SLA at 99.40% and 99.80%
• Improving production• Quality• Expedience
