Claims

The claims function is central to the health plan business model. Payers that fully leverage the power of automation can improve the accuracy and timeliness of payments to reduce administrative costs and increase the satisfaction of members and providers.


Catalyst will help:


  • Optimize System Configuration
  • Business Process Improvement
  • Process Claims
  • Outsource Claims Processing
  • Policy & Procedure Documentation
  • Training & Training Development
  • Quality Assurance
  • Workflow Management Optimization

Contact Center

The call center of a healthcare plan has made significant progress over the last two decades. Telephonic technologies are still employed, but so are e-mail, webchat, texting, portals and social media services. Great strides have been made in automation and workforce management, which allow healthcare plans to maximize the use of their call center agents. Intelligent software allows agents to proactively manage members’ health, which is especially beneficial in concert with targeted outreach campaigns. Mature call centers don't focus solely on solving customer issues, but on demonstrating the power of their brand, which drives customer satisfaction and loyalty.


Catalyst will help you build the contact center of the future through:


  • Contact Center Strategy
  • Technology & Tools Selection & Implementation
  • Business Process Improvement
  • Informatics, Analytics, & Reporting
  • Automation
  • Training & Training Development
  • Workforce Management
  • Portal/Web/Mobile Strategies & Apps

Billing

Members and subscribers have become immensely more sophisticated and their expectations around ease and flexibility of payment have increased. Cash and checks used to be the only ways consumers could pay their bills, but advances in technology have enabled billing departments to provide new channels and payment methods, including: IVR and web portals, used through the users computer, smart phone or tablet. Further, new technologies have allowed healthcare plans to increase security, while automating the back-end processes to maximize efficiencies and drive down costs.


Catalyst will help with:


  • Business Process Improvement
  • Policy & Procedure Documentation
  • Member Data Clean-Up
  • Optimizing Data Flow Accuracy
  • Training & Training development

Enrollment

The first experience consumers may have with a health insurance plan is in the enrollment process. Plans can take this opportunity to make a positive first impression by ensuring member information is accurately entered into the core system and that the customer is ready to take advantage of their medical benefits on day one.


Catalyst will help with:


  • Business Process Improvement
  • Policy & Procedure Documentation
  • Member Data Clean-Up
  • Optimizing Data Flow Accuracy
  • Training & Training development

Provider & Provider
Data Management

Provider networks have been a mainstay of healthcare payer landscape for almost four decades. These networks provide consumers with access to a broad range of hospitals, physicians and specialists. The relationship between payer and providers creates financial benefits for members to obtain medical care within the plan’s provider network.

The process to build these networks and to credential and contract with these physicians is significant.


Catalyst will help with:


  • Provider Network Strategy
  • System Integration
  • Current-State Evaluation & Recommendations
  • Training & Training Development
  • Process Documentation
  • Configuration
  • Reporting
  • Automation

Moreover, provider network information is difficult to manage and maintain and the penalties for inaccurate data can be steep. Catalyst provides plans the ability to analyze, manage, configure and sync data, turning provider data from a liability in to a strategic asset. Catalyst will help with:


  • PDMS System Selection and Migration
  • Provider Data Clean-Up
  • Reporting
  • Automation

Configuration

Health plans with well-designed configuration can achieve lower operational costs, improved claims payment accuracy, and fewer pended claims –all important for provider and member satisfaction. Changes to the marketplace drive health plans to introduce new products and enter new lines of business. This creates new business rules which drive changes to configuration and many health plans struggle to keep pace. Catalyst has extensive experience working with all major claims platforms and can transform configuration to meet the needs of the plan.


Catalyst will help with:


  • Configuration Design & Build
  • Business Rules Optimization
  • Systems Implementations & Upgrades
  • Configuration Optimization & Re-Design
  • Configuration Supplemental Staff

Business Process Optimization

Adaptability is key for health plans looking to contain costs and stay relevant in an ever-changing regulatory and consumer driven market. With increasingly lower margins, it is imperative plans drive a culture which embraces operational optimization and rewards cost-savings throughout all areas within a health plan.


Catalyst will help with:


  • Business Process Analysis & Optimization
  • Meaningful Metrics, Analytics & Reporting Capabilities
  • Aligning Business Objectives with Technology
  • Design, Standardization & Implementation of Business Process Documentation
  • Maturity Modeling
  • Aligning Organizational Structure with Business Functions
  • Training
  • Communication Strategies

Operational Readiness

Project teams are very effective at introducing new or optimized technologies, changing business processes, launching new products and helping the business comply with new state and federal regulations. Often, however, these project teams fail to ask a critical question: how will this change affect operations?

The key focus of Catalyst’s Operational Readiness services is managing the human element of project implementations and minimizing the negative effects of change on the workforce. Operational Readiness helps the plan’s resources understand their jobs from end-to-end and ensures productivity and efficiency are not adversely affected by whatever change the project team introduces.


Catalyst will help with:


  • Change Management/Adoption Strategy
  • Future State Process Documentation & Desk-Level Procedures
  • Key Stakeholder Engagement & Communication Plans
  • Future-State Job Descriptions & Org Charts Development
  • Backfill Strategy & Resourcing Support
  • Updating System Profiles & System Access
  • Process Testing
  • Success Metrics for Change
  • Training Employees on New Processes & Technology

Change Management

Change is an inevitable part of business, especially in an industry as dynamic as healthcare. Plans are always facing change, whether it is from introducing new and better technologies, streamlining business processes, adopting new programs to better serve customers, complying with new state and federal regulations, or customer mandates.

One of the most common reasons a plan’s program fails is because key stakeholders and end users are not properly engaged. Buy-in and adoption are critical, because resistance is the natural response to change.


Catalyst will help:


  • Build Executive Sponsorship
  • Staff Engagement
  • Adoption Management
  • Communication Strategy
  • Training

Learning Management

Learning Organizations encourage employees to grow and develop knowledge and new competencies. In addition to providing training, a Learning Organization nurtures creativity and creates a culture of innovation and continuous improvement.


Catalyst can:


  • Develop Curriculum Paths
  • Build Training Models & Materials
  • Train-the-Trainer & Trainer Certification
  • Establish Training Metrics
  • Training Technologies
  • Institute Learning Management Technologies

Training

When moving to a new technology or changing roles, it’s critical that employees learn the tasks necessary to effectively do their job. Based on adult learning theory and instructional design practices, Catalyst’s training incorporates the most critical learning objectives related to the technology and/or role to ensure employees are well prepared to meet established metrics.


Catalyst provides:


  • Classroom Facilitation
  • Train-the-Trainer
  • Training Manuals
  • Desk-Level Procedures
  • Job Aids

Operational Governance

Governance provides organizations the mechanisms to ensure accountability, transparency, responsiveness, stability and inclusiveness through policies, procedures and structured oversight.

Catalyst will help provide a Governance framework to identify the accountable and responsible participants in the plan (and outside the plan) and includes the rules and procedures related to:


  • Project Identification & Queueing
  • Project Oversight

Organizational governance also includes the processes through which corporate objectives are set and pursued, which includes:


  • Policies
  • Procedures
  • Metrics/Reporting
  • Stakeholder Engagement and Communication
  • Risk and Issue Management
2353 S/b Broadway. Denver, Colorado. 80210
303-393-8818 | 800-903-9574 | 303-393-8838