Ensuring Smooth Transition to Comply with Healthcare Mandates

To ensure a smooth transition to one of the largest implementations of the NASCO Claims Processing System, which is used in all of the BCBS Plans accross the United States.

The Client: Blue Cross Blue Shield

The Solution

Saras America Provided testing support to various Blue Cross Blue Shield Plans for their implementation of BCBS Association Mandate Projects. The Projects have been identified as the corporate goals for the year. This support involves writing test cases, creating test data and properly executing the projects.

The Challenge

The Tools

The Solution

The Tools

NASCO Claims Processing System
TSO
IBM CQ
BFM (Benefit File Manager) Benefit Configurator
Oracle
MS-SharePoint Microsoft Products

The Results

Saras America implemented Windows SharePoint Services (WSS) 3.0, allowing the
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in a very efficient and streamlined manner.

The Results

The quality of the projects implemented in this production was flawless, leading to extreme client satisfaction. This implementation was prompt, on-budget and involved solid planning, resulting in no penalties for the healthcare company.

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Marketing Business Plan for better result

CHALLENGES FOR MANDATES

Developing test cases from the CSD, which was often unclear in previous projects and needed business and technical Meetings which were required to obtain the input delayed the process.
Creating data for this testing – which required support from the EDI department as well as other SME’s. Meetings that were required to obtain input ultimately delayed the process.
Test Environment Set-Up and coordinating with the TEM (Test Environment Maintenance) team.
Validation of test cases depending on environmental availability.
Delay during the BRD phase and/or any subsequent phases at the beginning or in the middle or at the end of the Project Life Cycle would majorly impact the timelines apart from the original implementation strategy. Avoiding federal/state penalties would require dynamic changes to the originally agreed implementation strategy which in turn results in increased Project cost.

By developing customized tools, we were able to improve the methods of creating data, thereby facilitating the interaction with the EDI team. All of these tools were reviewed and approved by the SME’s.

During the business sign-off process, executives wanted to have more test data but there were no test scenarios left. In order to further build confidence, we developed a new testing strategy called “Volume Testing.” In this new test strategy, we ran millions of production claims against the test region. We compared these results with the actual production claims processed and generated various reports to the client’s satisfaction.

THE MANDATES

BCBSA MANDATE

Lines Dollars Units Expansion Strategy

This strategy is a BCBS Association mandate to upgrade the NASCO system to accept 999 lines for a facility and 50 service lines for a professional user. In addition, this mandate was implemented to accept up to 9999 units and $1 million on the claim. Implemented in December 2008, this project involved ten months of rigorous analysis with the testing team.

BCBS PLAN MANDATE

TRLOG to 837 Conversions

The goal of this project– to change the source of input to the 837 transaction from TRLOG–was implemented for one of the biggest BCBS Plans which was the corporate goal for 2009. This was a complex project involving BCBS Plan claim processing in NASCO.

Local Migration to NASCO (MOC)

This project involved moving the BCBS Plan business outlook from their local platform onto the NASCO processing system. This program had multiple major releases in 2008, 2009 & 2010, producing significant savings for BCBS Plan, as well as possible reductions in premiums for subscribers.

FEDERAL MANDATE

HIPAA 4010 to 5010 Conversion
This HIPAA mandate mandate is required to be implemented no later than December 2012. However, BCBS has internal timelines that target completion in 2011. Saras America will meet those goals.Saras America is on track to meet those goals.

For all projects mentioned previously, our testing support was critical for the delivery of planned implementation timelines

NASCO Expertise Critical During Implementation

For the finished projects previously mentioned or in progress for implementation on NASCO, our team comprised of ten testers from SARAS America, Inc. as well as various technical and business experts. Our NASCO expertise was critical for building relations with technical and business teams.

Because these were huge testing projects, defects were identified during SIT and UAT phases. Our team, in a collaborative effort, coordinated with technical counterparts in BCBS by identifying defects and ultimately confirming that the defects were properly fixed.

Once this testing was completed and the results accepted – the projects were implemented.

The lead Saras consultant on this initiative “played a very critical role in major BCBS Association Mandate

projects and was [a] key member in ITS HOST implementation team. He is very knowledgeable of NASCO TRLOG scrubber processing, 837 processing from EDI front end to the claim processing in NASCO system which is

used by most of the BCSB plans. He was the “go to guy” for any test data for any ITS HOST testing for BCBS Plan. He has very solid concepts of DB2 and CICS programming and developed lot of tools using JCL.”

Saving Testing Costs for the Clients

Saras’ solid knowledge of the NASCO claims process led to significantly reduced costs for the migration project. Saras developed numerous testing tools for both creating and validating data. These tools helped the client reduce testing costs and also improve quality.

Utilizing a team size of ten members comprised of SME’s in different areas considerably helped the testing timelines and effort. Because the client’s business and technical departments were comfortable with the methodologies utilized by Saras, considerable time was saved in the review process.

“They took on a substantial workload in the testing area and within a few months of a project that required the the team members to be immediately productive, they came out as a top tier vendor. You need a meticulous, objective, and trustworthy group of testers who will not yield to the folklore of the programmers that

“they did test everything and no bugs were found” but instead will “trust but verify”.

Setting the Right Processes in Place

As experts in analysis, design, testing and implementation of the claims processing systems, Saras have capabilities in the functional areas that include (but are not limited to) HIPAA transactions, benefit file processing, membership,pricing, EFT, and remittance. Within the claims processing systems, Saras have expertise in providing design solutions and testing in complex areas such as COB processing.

Testing, the most complex part of the project life cycle, involves identifying all changes that will impact the project. Regression testing is always a key factor in insuring the integrity of the system. Any gaps in the testing would lead to PHI and compliance issues, which would then lead to massive penalties imposed by the government. The major work for all project testing is generating data that creates the claims and the possible claim scenarios in production.

Based on project requirements, Saras has created several tools to pull data from the input file. Saras has also developed a proprietary automated tool that is used to change the input file based on our need for human error-free data.

Saras have created several scripting tools to identify the scenarios in production claims that match test scenarios and pull the required fields. These required fields are used to pull the data from the input file related to to that particular claim. This approach reduces the work by approximately 10%.

Targeting a test case scenario involves preparing all possible combinations of scenarios for a test case and includes preparing complex test data, which will reduce the time and effort needed for retestin