A non-profit health plan provider serving members in Massachusetts offers a range of health care plans in the commercial, Medicaid, and Medicare markets.
The essential element in value-based health care is payer-provider payments. The client's aim was to transform its claims and enrollment processing system.
The client engaged Mphasis to help them with their business and IT transformation journey, and over the years, this partnership has accelerated the experience for their teams and end customers. To begin with, Mphasis did the gap analysis of the processes to enhance IT and business operations while ensuring security and compliance.:
Our innovative implementations delivered the following outcomes:
15k+ claims repriced in less than an hour
Achieved 90% improvement in process efficiency while enabling flexibility for plan configuration and pricing edits
Implemented Enrollment HUB Automation process for small trading partners who are sending enrollment details through excel formats, which led to an over 85% reduction in manual tasks
Enabled a needed layer of flexibility for claims processing
Provided a robust enrollment hub to include 60 trading partners as compared to 16 partners earlier
Automated 70% testing process by using automation tools and process
Automated client's onboarding process by introducing RBAC (Role-Based Access Control) model to reduced paper work