East Coast Medicaid Plan
Wendigo Advisors was called in by an East Coast Medicaid plan that had been put on Corrective Action by the state. Wendigo worked with the plan to improve its core system configuration and processes.
Issues Faced
Our client faced a myriad of issues including:
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Slow Claim Payment
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Six-Figure Monthly Interest/Penalties
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Eight Weeks of Claims in Backlog
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Encounter Submission Issues
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Lack of System Knowledge
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Strained Vendor Relationship
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Backlog of Configuration Updates
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Regular Payment Processing Failures
Diagnosis
Wendigo review and research included:
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Analysis of system configuration
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Review of vendor contracts
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Log/DB Analysis for Payment
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Examination of System Code Sets
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Review of Custom Code
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Evaluation of System Skills
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Review Configuration Processes
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Review User Security Settings
Wendigo Team
The Wendigo Team included:
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Exec Oversight/Interim CIO
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Interim Claims Director
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System Configuration SMEs
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QNXT Technical Architect
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Software Development Specialise
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Claims Processors
Results
Auto Adjudication
Wendigo worked with the client to improve processes and configuration settings resulting in improving their auto adjudication rate from under 30% to nearly 80% in 6 months
Claim Backlog
Wendigo provided experience claims processors to work through eight weeks of backlog and eliminate 6-figure monthly interest and penalty payments.
Claim Interest/Penalties
Our clients backlog of claims was costing ~$50,000 per week! By reducing the backlog and improving the auto adjudication rate these costs were eliminated.
Encounter Submissions
Wendigo analyzed processes and past encounter submissions. Improving processes allowed resubmission of previously rejected encounters resulting in nearly $10,000,000 in recoveries.
