Client Description
The client is a diversified healthcare company servicing more than 87,000 patient and plan members, mostly Medicare-eligible seniors in several states in the Southeast. The organization is recognized as an industry leader in medical risk management, highly effective disease management, and chronic care programs and healthcare delivery services.
Challenge
Having recently acquired a new health plan, the client needed support for the transition and ongoing management of its IT systems, including the integration and support of multiple legacy systems.
Technology
The technologies included in the scope of work were Health Plan Administration, Billing, Reporting, Portal, Claims, EDI, Authorizations, and Care Management. It involved three software vendors with multiple solutions.
Ninestone’s Approach
The client chose to work with Ninestone because of our ability to understand the client’s strategy, manage the project, and execute the work on time and within budget. On this project, we served in several roles, such as project manager, technology consultant, testing coordinator, and interim IT manager.
As project manager, we planned, directed, and coordinated day-to-day operations for multiple systems and multiple payor implementations. We managed the system environments and ensured that service level agreements were met, participated in onsite HEDIS audits, managed the delivery of the quarterly CMS reports, and supported the Medicare business from multiple legacy systems to the new health plan administration solution. For testing, we oversaw the creation and maintenance of testing environments, coordinated internal and external code delivery, scheduled test and production environment code moves, and decommissioned unused or outdated IT platforms and servers.
Throughout the project, Ninestone acted as the interim IT manager and managed internal employees and an offshore development team while maintaining key client relationships.
Results
The client was pleased with the outcome of this complex project. We successfully managed the run out of the commercial line of business on a legacy system, completed HEDIS and CMS reporting in a timely and accurate manner, and migrated the Medicare line of business on time and within budget.