Client’s Challenge
Errors Following Annual Enrollment Period (AEP) Updates
Our client, a major health insurance payer, needed to prevent the occurrence of errors after significant updates were made to members and their plans following AEP.
Case Studies
Improving Member and Provider Experience Following Annual Enrollment Period
Mitigating Errors on Critical Documentation and Claims Processes in New Plan Enrollment Period
Our Solution
Develop a Test Data Staging Process
Our team provided the client with a strategic claims data staging process to strengthen testing efforts and reduce errors.
Value Realized
Elimination of Major Issues
All major issues were mitigated in the new plan year.
Project Details
A major health insurance payer was experiencing claims processing errors following annual enrollment periods when complex updates across multiple systems were being performed. They needed a project plan and improved testing procedures.
They engaged InfoWorks to provide project management and software testing services for the new plan year implementation for the Claims Payment Integrity functional area. This area is responsible for the Explanation of Benefits (EOB), Explanation of Payments (EOP), Integrated Denial Notice (IDN), Coordination of Benefits (COB), and Maximum Out of Pocket (MOOP). Our team was able to provide strategic project management oversight to ensure all aspects of the Annual Enrollment Period (AEP) were captured in all systems and incorporated in the test plans. We developed a comprehensive process guide, empowering the client to seamlessly repeat the new plan year process annually.
Using the claims data staging process we developed, the client was able to strengthen testing efforts. For the first time in recent years, they experienced no major issues in production in the new plan year.
