Affordable Care Act – Implementation

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Engagement Summary

One of the client needed to address fast-paced growth, industry changes that were affecting day-to-day operations, and the functioning of its health plan administration system.

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Challenges

  • Keeping up to date with Trizetto releases
  • Verifying the impact on existing business
  • Implementation of Affordable Care Act
  • Managing accumulators information from different systems.
  • To and fro communication of accumulator information between different systems.
  • Modifications in Commission calculation
  • Modifications in Capitation process
  • Migrating from Sybase to Oracle.
  • Data validation issues and gaps.
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Solution

  • Enhanced commission calculation process like automated overpayment identification.
  • Auto-mated solutions for loading accumulator in Facets
  • Alarming team with expected information on issues with data.
  • Thorough analysis of custom process as well as core Facets jobs was performed & areas of improvement identified.
  • Provided impact analysis on existing system and fixes to for every release from Trizetto.
  • Improved member enrollment process with our custom solutions.
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Results

  • Hassle less Facets upgradation of each release.
  • Accurate Broker/Agent commission calculation.
  • Improved accuracy of Capitation.
  • Better management of accumulators information.
  • Established a clear governance and processes.
  • Awarded as best company for up to date implementation of latest rules and regulations.
  • Successful migration from Sybase to Oracle.

Best Practices

  • Providing blue print for all use cases with business users which driven the project execution with quality and on time deliverables.
  • Proper ahead planning for extensive testing prevented unexpected surprises at the end.