A modernized approach of scalable digital infrastructure paves the way for future growth
Independent Health, an innovative health care plan focused on preventive care, has more than 1,100 associates serving nearly 330,000 members. The organization needed to update its billing software and replace its electronic billing and payment services to improve upon inefficient, disparate workflows and systems.
Several stakeholders convened to discuss the best approach to adopting new technologies. The Independent Health business unit managers for group, individual, and Medicare coverage, IT, operations, business analysts, finance executives, and bank representatives agreed on the importance of:
- New systems to address a growing need for new digital payment channels
- Redesigning various insurance bills for digital and conventional USPS distribution channels
To execute this upgrade, the health care plan wanted to outsource the work to an industry leader in changing technology and complex health insurance compliance requirements. A decades-long partnership between a growing Independent Health and RRD Business Communication Solutions (for EOBs, coverage and claims communications, and other correspondence) ensured a natural fit for meeting these needs.
Project managers and billing analysts from both Independent Health and RRD got together to kick off this collaboration. First, with direct input from the client, RRD gathered a comprehensive list of their needs and drafted a Business Requirements Document (BRD). The BRD defined and explained the scope of ePay, Independent Health’s new electronic bill presentment and payment system designed by RRD.
The document organized the categories of requirements to align with the billing cycle workflow, and each category contained associated tasks and timelines. This BRD provided a roadmap for development and migration. Categories within the document included:
- Bill file creation from billing system (XML format)
- New bill design for PDF and electronic presentation
- Bill design, business logic, and data mapping
- ePAY payment portal (branding and user interface)
- ePAY portal bill load workflow
- Accounts receivable reconciliation
- ePAY ACH and credit card processing
- Hardcopy bill print/mail workflow
- PDF archive/API
- Migration of electronic payment profiles from the current payment processor
Migration to new systems would touch tens of thousands of insured, and the top priority was to transition smoothly with no disruption for members. To minimize the impact, the process prioritized different member constituents and rolled out changes gradually. Group members were first in line for the upgrade, followed by individual and Medicare members.
The RRD-Independent Health collaboration resulted in a well-coordinated migration and upgrade. The outcome of this migration was transformational for the client in a few ways:
- A new digital infrastructure provides a scalable platform for many years ahead.
- By combining the file processing for conventional print/mail bills with that of electronic bills, the client was able to consolidate operations into a single thread.
- Future enhancements will come easily with this modernized approach to changes and modifications. This flexibility will prove essential as health insurance regulations and legislation evolve. Independent Health is now prepared to adapt to a health insurance environment with expanded digital touchpoints and flexible benefits management.