Achieving Payer Migration with “Zero Disruption”
About the Client
- Plan Type: Medicare Advantage
- Plan Size: 3M members
- Geography: Regional (multiple states)
Issue
A longstanding health plan client required urgent migration of their Medicare Advantage business from a legacy platform to Health Rules Payer®.
The health plan leadership made it clear that there must be “zero disruption to business” during the transition.
The project had an ambitious and extremely narrow timeline to ensure the plan’s Medicare Advantage members had no interruption in services or communications. In addition, it was critical to the health plan that providers have continual access to all necessary data throughout the project.
Action
Sagility ensured a smooth migration using workforce planning, training, testing, risk management, and stakeholder communication.
We met the customer’s timeline and data availability requirements for the migration from legacy claims platform by:
- Building a workforce management, training, and staffing plan
- Testing data switch procedures before the data exchange
- Creating a risk management plan to anticipate and mitigate issues during the project
- Engaging stakeholders with ongoing, transparent communication
The team’s expansion on Health Rules Payer®, from 10 FTEs initially, to the planned capacity of 276 FTEs unfolded in four carefully planned phases; each strategically aligned with task complexity and growing demands. To ensure seamless migration, seasoned professionals—trainers, team leaders, quality associates, and mentors—were handpicked.
This structured growth followed a wave-based staffing model to maintain efficiency, adaptability, and a smooth transition.
Impact
Sagility successfully migrated 3 million Medicare Advantage members from the legacy claims platform to Health Rules Payer®, without any disruptions to the health plan’s business operations. Data and services remained available — without any interruptions — to Medicare Advantage members and providers throughout the data transfer and migration process.
- 30% increase in claims processing efficiency because of the migration, reducing the staff required for manual processing of claims.
- We also identified and revised 46 ambiguous health plan policies with an overall effect of streamlining operations processes and improving claims accuracy.
Zero disruption migrating 3M members
increase in claims processing efficiency
ambiguous health plan policies that when addressed streamlined operations and improve accuracy.
