The health plan is affiliated with a large integrated delivery system in the Mid-Atlantic and serves over 200,000 members in Medicaid, Commercial and Department of Defense product lines.
The organization has multiple health plan administration and clinical systems supporting different lines of business and a complex hardware and software architecture. In addition, the health plan must meet all requirements from the health system. Overall, this client functions in a highly customized, complicated environment so completing any implementation project requires a great deal of planning and testing.
Ninestone was brought in to manage the testing phase of the ICD-10 compliant activities because of its experience with testing health plan software applications. The project involved developing a test strategy and executing the plan through extensive testing cycles to ensure that the new ICD-10 codes - as well as ICD-9 coding, existing reports and customizations, such as interfaces and extracts – functioned as expected to ensure a smooth transition.
The technologies included in the scope of the project were Billing and Eligibility, Care Management, Authorizations, Claims, Member/Provider/Employer Portals, Reporting, EDI and integration points.
Ninestone provided project management for the identification of business requirements related to the implementation of ICD-10 compliant technologies. Ninestone approached the project utilizing their vast experience with health plan system implementations and drew a close focus on risk mitigation. A comprehensive and detailed project plan was created and executed. The organization benefited from Ninestone’s approach to a multi-system related testing initiative, bridging the collection and reporting capabilities required for ICD-10 compliance.