Agile Claims Migration to Facets Platform Saves $11M
About the Client
- Plan Type: Multi-Line (Commercial, Medicare Advantage, Medicaid, ASO)
- Plan Size: 5M+ members
- Geography: California
Issue
A California health plan with 3.4 million members needed to modernize claims administration and upgrade its technology to stay competitive.
Recognizing the complexities of a large-scale technology overhaul, the organization sought a capable business process outsourcing (BPO) partner with deep healthcare operations expertise and proficiency in swiftly implementing claims administration processes aligned with upgraded systems.
This objective was to optimize end-to-end workflows while strengthening value delivery to members & providers and ensuring compliance with HIPAA and The Prompt Pay Act. The health plan knew the project would be complex and time-consuming, requiring careful planning and a phased ramp-down strategy to minimize disruption while maintaining efficiency.
The modernization effort reflected the organization’s commitment to innovation, enhanced service delivery, improved member experience, and growth in a dynamic healthcare landscape.
Action
Sagility ramped down the legacy platform and rapidly ramped up operations on Facets, ensuring HIPAA-compliant security. Technology teams from both organizations collaborated on a transition plan with zero service disruptions.
Sagility migrated Commercial, Medicare Advantage, ITS, Medicaid, and ASO claims to optimize quality, maintain data integrity, and ensure error-free transitions.
Flexible staffing enabled simultaneous data entry during the shift to Facets®. A major challenge—irregular claims inventory—became an opportunity through cross-skilling initiatives, allowing 80% of the team to operate across 60 queues, including research, recovery, crossover (XC) claims, and benefits coordination.
Sagility preserved data integrity with comprehensive conversion methodologies, completing 80,632 work hours and processing 500,018 ad hoc claims. After the migration, Sagility expanded its role to ongoing Facets support.
Impact
Sagility continues to deliver transformative results for this client, including significantly faster processing times and a notable reduction in turnaround time.
As a pivotal contributor to these outcomes, Sagility has achieved a remarkable improvement in the TAT for claims processing, including:
- $11 million in savings from the migration to date.
- 99.8% of claims are processed within 30 days, which marks a considerable improvement from the previous performance benchmark of 98%.
When the engagement began, Sagility managed 20% of the client’s support needs. By the project’s end, 80% were entrusted to Sagility.
Today, Sagility is the sole provider of these services for the client. This transition to become the exclusive service provider underscores Sagility’s role as a trusted and preferred partner.
in savings from the migration to date
of claims are processed within 30 days
increase in client's support needs
