Project For a National Senior Market Health Insurer

CHALLENGE

The executives of a national Medicare Advantage health plan wanted to adopt a common information systems platform for all of its products in the Medicare-eligible population. The health plan had selected the TriZetto-hosted Facets product as the core claims processing system. The Facets application was already supporting the plan’s Preferred Provider Organization (PPO) and Private Fee-for-Service (PFFS) products; the health plan needed to migrate their HMO product to Facets from the EZ-CAP system to create a single, enterprise-wide information solution.

In order to implement Facets within the HMO product line, the operations leadership of the health plan required functional and technical expertise to work with their end-users and the health plan’s Information Technology (IT) Department.

 

SERVICES

Advanta staffed the effort with a project manager, who had more than 10 years of Facets implementation experience with a wide range of plan types, along with a project team, throughout the lifecycle. The project manager and the team:

  • Elicited and documented business requirements
  • Conducted a gap analysis between identified business requirements and system capabilities
  • Developed and documented new business processes and workflows to define the “new” operational model
  • Developed policies and procedures to support new operational model
  • Created desktop and job aides to support future processes and workflows
  • Facilitated decision-making around system configuration
  • Provided testing support, including user-acceptance testing (UAT)
  • Developed and provided staff training on the new operational model and system functionalities
  • Staffed go-live and post-deployment activities

 

RESULT

The migration of the HMO business from EZ-CAP to TriZetto Facets was successful and became the foundation for achieving planned operational improvements and cost reductions.