1 Planning Meet with key UCSDH stakeholders Introduction to TEAM and Process, Familiarize with Standard Work Processes/Procedures (SOP) Meet with new clearinghouse and internal stakeholders to begin the process of preparing for implementation -Project Plan approved by all stake holders -Risk Mitigation Plan Within 30 days of Start date Proposal Task 1 concurrent to Task 2 2 Pre-Audit Review Historical CEWQ 733 Exports, Notes, Completed Tickets Audit of current Process & SOP to identify claims rejections due to formatting issues and types to update system build Review of current payer volumes, dollars and record requests to determine how best to allocate volumes between clearinghouses -Provide updated SOP recommendations and timeframes to eliminate recurring claim format errors -Recommendation of how to split payers between two clearinghouses -Initial project plan for new clearinghouse implementation Within 60 days of start date Proposal Task 2 Concurrent to Task 1 3 Process Development Create and document claims processing functions for both clearinghouses to be used for ongoing build, support, maintenance and staff training Create formal process for the rapid identification and resolution of claims processing errors as they arise Develop tools for ongoing monitoring of claims submission accuracy -SOPs and Work Instructions for implementing the new clearinghouse -Creation of workflows and process documents for claims processing (clearinghouse specific) Within 75-days of start date Proposal Task 3 concurrent to Task 2 6 Training Provide training to staff on clearinghouse procedures and processes -Trained and qualified staff In coordination with Clearinghouse implementation schedule 7 Quality Assurance Parallel Claims testing of formatting/build between the two clearinghouses Monitor quality of staff execution of new processes and addressing the claim rejections Monitor daily claims and record submissions at time of new clearinghouse go live to ensure cashflow is not negatively impacted -Ensure unique formatting requirements are met for each entity -Quality review documentation -Establish defined process for tracking issues impacting timely claims submission Within 60-days of formal process implementation 9 Go-Live/Post Go-Live Establish metrics to ensure a smooth clearinghouse transition -Identification of expected claim volumes and rejections as well as standard KPIs for management to follow in the resolution of rejections
