Client Profile:

A diversified health and well-being company dedicated to helping people live healthier lives and making healthcare work better, this large healthcare payer orgnanization manages HMO, PPO, POS, Medicare & Medicaid and Pharmacy Benefits Management services. Through a range of subsidiaries and business divisions, this company serves more than 70 million people worldwide.

Furthering their goal to help people lead healthier lives, the company turned to ICD-10 conversion and TriZetto Facets subject matter expertise from Upp Technology as part of their product build plans for supporting healthcare reform.

Solution:

Upp Technology project managers, subject matter experts in HIPAA 5010 & ICD-10 as well as TriZetto Facets, business analysts, and quality assurance managers have played an integral part in project-based HIPAA 5010 implementation for Behavioral Health PBH Facets, ICD-9 to ICD-10, and DSM-IV to DSM-V conversion, migration and remediation, including plan, build, deploy, operate activities.

Working closely with business unit leaders and cross-functional team members, Upp Technology project managers specializing in all aspects of healthcare IT, including EDI, claims, eligibility, membership, billing and finance are managing strategic remediation and conversion initiatives, aligning system requirements with those of business.

This includes development and implementation of project plans from writing SOWs to QA and post-deployment plans; conducting impact analysis and developing remediation plans; managing teams comprised of on-premise, off-premise and off-shore staff; controlling budgets; producing documentation for internal migration; and reporting through the EPMO.

Upp Technology SMEs off premise have also taken a leading role in related TriZetto Facets engagements. Working remotely, the team has provided Facets Benefits configuration, built out Products and Claims, reviewed Provider contracts for validation against Provider/Pricing configuration, used NetworX for APC codes including linking procedures, and documented, tested & audited the new Facets configuration.

Business Value:

Upp Technology healthcare expertise in HIPAA 5010 & ICD-10 and TriZetto Facets, leading translation of this major payer's complex business healthcare requirements into their enterprise healthcare IT systems, has helped transition to the enhanced code sets for more efficient claims processing, and achieve security & compliances in HIPAA, while meeting stringent remediation time lines.