Blue Cross and Blue Shield of North Carolina (BCBSNC), one of the state’s largest payers, had already invested two years into a multi-stage Cognizant’s TriZetto® Facets™ enterprise core administration and billing/claims processing implementation. This was conducted across multiple lines of business when a third-party vendor error and system failure led to a well-publicized problem with their system. Roughly 25,000 customers were accidentally enrolled in the wrong plans, and about 3,200 were charged the wrong amount for their plan; some were even charged for multiple plans.
BCBSNC turned to Mediant Health Resources for rapid remediation, a system redesign, knowledge transfer, and project management in assuming responsibilities from this client’s previous vendor. Read further to discover how Mediant helped this payer put their Facets implementation back on track.
Since 1933, BCBSNC has provided high quality health insurance at a competitive price. Among BCBSNC’s initiatives has been a transition toward better health and more consumer-focused health care in their state. BCBSNC employs more than 4,700 North Carolinians and serves more than 3.89 million customers. Their PPO network
includes 96% of medical doctors and 99% of all general acute-care hospitals in the state.
In order to better support industry changes, such as the Affordable Care Act, Blue Cross Blue Shield of North Carolina chose to upgrade their enterprise core administration platform to TriZetto Facets.
Implementation of their new Facets system began with a multi-staged rollout, and the claims processing migration started in April of 2014.
The integration and migration of the Facets claim system can be challenging. The system provides a highly automated solution, and failures at the system design and configuration phases can lead to inaccurate processing and subsequent issues. Seasoned experts are needed to provide the proper insight and support to build a well-designed Facets system.
In early January of 2016, with another vendor, BCBSNC experienced the challenges of a Facets implementation first hand in a very public way. Due to a system failure and human error by an outside claims and billing vendor, customers were accidentally enrolled in the wrong plan and incorrectly billed. This resulted in many customers being unsure whether or not they still had coverage.
This incident, with two of their business lines, halted further migration of future businesses to BCBSNC’s Facets build. In addition, the staff for the already migrated lines were not sufficiently trained to complete daily remediation.
Blue Cross Blue Shield of North Carolina sought a trusted partner who could provide proven subject matter expertise with immediate availability. After a thorough search, BCBSNC selected Mediant Health Resources as their partner. Mediant’s strong industry reputation for providing outstanding, experienced FacetsTM consultants was the deciding factor.
Mediant has a depth of talent that allows us to ramp up quickly regardless of need says BCBSNC’s Sr. Director Facets Configuration Oversight Andrew Jablonski. “We have had the opportunity to leverage senior, mid-level, and basic skill resources depending on our need.
Mediant’s team immediately provided several supplemental experts via a staff augmentation model. These veteran consultants were able to quickly join with the organization, complete a review of current system setup, and provide recommendations to improve performance. Mediant consultants then took the lead in developing solutions for BCBSNC’s current claims issues, and partnered with the payer’s full-time staff to provide knowledge transfer of their skills. The latter was integral to improving the overall understanding of Facets for BCBSNC’s staff.
Mediant also provided exceptional Program Manager consultants to guide the transition of billing and claims processing responsibilities from Blue Cross Blue Shield of North Carolina’s outside vendor to BCBSNC’s full time staff.
In total, Mediant consultants provided:
• Daily operations support
• System triage
• Solution implementation
• Transition project management
• “Correct AND train” knowledge transfer
Aspects of the overall project are currently ongoing; however, Mediant Health Resources’ involvement yielded tremendous results. Says Jablonski, “In both engagements Mediant has provided superior support allowing us to reduce issue volume, improve corrective action turnaround time, and improve our member experience.”
As of this writing, and as a direct result of Mediant’s support:
• New daily production issues were reduced by one third
• New system design was completed within 15 days
• Transition project milestones were on track and “all green”
Additionally, the program manager experts Mediant provided demonstrated a solid technical understanding, the ability to clearly communicate with non-technical resources, demonstrate a capability to interact with senior level management as well as provide leadership for the junior level staff. According to Jablonski, “Mediant excels in this skillset, and demonstrates correct escalation when needed as well as driving resources in a ‘correct AND train’ mode for junior level BCBSNC resources.”
Not only has the payer experienced exceptional results, but Mediant made the process as painless as possible. Mediant is the epitome of a solid business partner, says Jablonski, when dealing with consultant firms, we have an expectation that the firm will provide solid resources, assist with onboarding, support expense reconciliation, and provide resources at competitive rates. Mediant met those expectations and more.
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