Se ha denunciado esta presentación.
Se está descargando tu SlideShare. ×

Program Overview

Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Anuncio
Próximo SlideShare
Program Overview
Program Overview
Cargando en…3
×

Eche un vistazo a continuación

1 de 22 Anuncio
Anuncio

Más Contenido Relacionado

Más reciente (20)

Anuncio

Program Overview

  1. 1. Firstsource & Molina Engagement Update Addressing the “Moments that Matter” for Healthcare Constituents with a Digital First Digital Now Approach
  2. 2. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 2 Your Extended Operations Team… Relationship Council Harish R Client Relations Molina Vendor Manager Steering Committee Anup Panthaloor Global CRM Molina Operations Leadership Srikrishnan Srinivasa Global Delivery Molina Vendor Teams Transition/ Project Manager Workstream Leads Transition and Delivery Teams Executive Sponsors Molina Executive Leadership Venkatgiri Vandali President - Healthcare Molina Healthcare Firstsource Molina Service Delivery Team LEVEL 3 - Steering Committee • Led by CRM • Agenda - Review high level program progress • Escalate issue to Exec Sponsors Level 2 - Project Review • Led by Project Leads • Agenda - Review progress on plan, actions and risks • Escalate issue to steering committee LEVEL 4 - Exec Committee • Review & Sign off Program and exceptions if any Level 1 - Project Working Group • Functional leads from Firstsource and Client partner collaborate on respective aspects - People , Process, Transformation, Financials • Led by Project Lead and attended by Work stream Leads, • Agenda - Review Tasks, Actions, RAID (risks, assumptions, issues and dependencies) as per Project plan. Also review Mitigation planning and Resourcing. Sundari Sethuraman Delivery Head – Claims & Enrollment Gnanasekar A Director Transition Reetoopan Kaushik VP - Capability Development Sasikumar D Director - Operations Dinesh Ramesh Director, Operations Escalation Levels Operations – Claims | Enrollment Processing | Digital Intake HR/EE IT Training/ Quality Recruitment WFM Infrastructure BCP Transformation Micheal B VP - Operations Kim B AVP - Operations Shreekant K AVP - Operations Murali Delivery Head – Digital Intake Darren L Senior Director - Operations Padmini R VP - Operations
  3. 3. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 3 Our Journey with Molina Claims Adjudication Adjustment | Recovery | Call Tracking 2006 Enrollment – Offshore Marketplace Expansion 2015 2016 Enrollment – Onshore Marketplace 2019 Claims Adjudication Offshore Expansion 2020 Initiated Assisted Automation Expansion into KY Claims & Affinity NY 2021 Initiated Unattended Automation Contact Center – Onshore MMP / MAPD Enrollment Expansion Initiated Mailroom Operations 2022 Claims Expansion VA Medicaid & KY MP Firstsource Support across 15+ states in 3 towers 779 Active 286 United States 400 Philippines 93 India 15 Years
  4. 4. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 4 Claims Tower Update 15+ Years of Partnership SCALE Of OPS QUALITY HEADCOUNT PERFORMANCE Medicaid – 16 States Marketplace – 11 MMP - 6 • ATA Financial Accuracy tracking @ 99.5% • Molina Claims audit monthly report 99.56% Financial Payment Accuracy 270 FTEs US 203 | IN 67 Consistently meeting State TAT guidelines KEY UPDATES • Processed 8.6 Mn (3% growth from 2021) claims from Jan’22 – Oct’22 (860K / month) • Transitioned VA health plan in Jul’22 with 20 FTEs • Transitioned KY Marketplace • 13 States FS is supporting as Primary • Firstsource developers trained on Assist Edge RPA • Edits automated using Sympraxis will be migrated to Assist Edge – Expected Go live Q1 2023 • Partnership has strengthened which has resulted in improved ATA results & quicker reconciliation process (reduced from 60 days to 20 days approx.) • Initiated bi-weekly meetings with State leaders (4) on quality & more to be added in CY 2023 • Have demonstrated flexibility to handle any ad-hoc or spike inventory across multiple LOBs & States • Delivered 2 Six Sigma initiatives to improve denial accuracy and overall State wise error reduction - Molina External Audit - Financial Error Count dropped by 130 (58%) from Jan'22 (225) to Aug'22 (95) and Mis-paid $ dropped by $270K (38%) from Jan'22 ($717K) to Aug'22 ($445K) - 41% reduction in payment error & 60% reduction in procedural errors • Improved governance around adjustment projects – consistently meeting project wise TAT expectation
  5. 5. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 5 Claims FS Landscape Tower Medicaid MP MMP MAPD Claims
  6. 6. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 6 Enrollment Tower Update 14+ Yrs of Partnership LOB INITIATIVES HEADCOUNT PERFORMANCE Federal programs : Medicare (MAPD ) State Program : Medicare Medicaid Program (MMP). Exchange : Marketplace • RPA Solution identified for MMW automation for MP, MMP and MAPD • Data entry automation (AEE tool) for MAPD apps 72 FTEs US - 46 | IN – 26 30% staffs cross trained between MMP and MAPD Consistent meeting Quality and TAT in MP Recovered performance in MMP / MAPD - Successfully completed AEP 2023 KEY UPDATES • Partnered with Molina to create TAT compliance reports in MMP /MAPD • MP Avg 14K volume processed monthly H1 2022 - 121K processed • MMP Avg 16K volume processed monthly • MAPD Avg 26K volume processed monthly • Volume forecast vs receipts – 87% for Q3 • Delivered 99.1% within the agreed timeline for FS on AEP volumes, Successful AEP’23 completed in collaboration with Molina • During AEP:FS worked 470 hrs after shift hrs /weekend support & was appreciated by Molina ops • Overall performance : Average of Q3 : TAT – MMP 86% | MAPD 93% and FS Accuracy is MMP 95.72% | MAPD 93.18% • Medicare Letter monitoring helped to be compliant • 2023 Focus area : Automation, possibility to Offshore Medicare work, Plans for MAOP - LMS Report to be created for compliance tracking MMP / MAPD MP • Team met and exceeded quality consistently 12 months in a row (Target 99% and Actuals 99.43%) • Demonstrated flexibility in scaling down & ramping up to support initial automation challenges (HPS automation) • In the last two quarters team has delivered 18 Adhoc project by working during weekends and Holidays. Molina has appreciated for the flexibility & partnership provided by FS
  7. 7. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 7 Member Enrollment FS Landscape Tower Medicaid MP MMP MAPD Claims
  8. 8. Molina Texas Marketplace Claims Adjustment - Process Mining Analysis
  9. 9. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 9 Process Mining – TXMP Adjustment (Interest & Penalty Analysis) Total claims (Year 2020) 23,887 claims Average Turnaround time 304 days Penalty, Interest paid - $8.2m (for claims in scope) Improvement oppurnities - $5m (60% reduction Interest and Penalties) S.No POC Outcome Potential Opportunities 1 62% of claims that get into Adjustment were processed by Machine ids. Address gaps in logics, enhance Auto Adjudication business rule to divert Claims for manual adjudication at first pass level. (Example: Mass should not process a claim, if enrolment data is empty) Timely loading of correct Provider • Contract info • Benefit Config Member • Configuration • Benefit coding 2 75% of the Claims are adjusted due to issues related to CONFIGURATION (47%), ENROLLMENT (15%), HEALTHPLAN (13%) $ Impact – 41% of total Spend. CONFIGURATION • CONTRACT - 52% • CODE EDITING - 39% • PROVIDER - 7% • BENEFIT - 2% ENROLLMENT • MEMBER CONFIGURATION- 63% • INCORRECT BENEFIT CODING - 35% • COB INFORMATION - 2% HEALTHPLAN INCORRECT BENEFIT CODING - 54% EXCEPTION - 42% PROVIDER BILLING - 3% Detailed analysis and corrective actions to be taken on top issues 3 CLAIM EXAMINER ERRORS 17% of the Claims are adjusted due to Manual errors $ impact – 33% of total Spend CLAIM EXAMINER ERRORS • SOP NOT FOLLOWED - 89% • MANUAL CALCULATION - 8% • DATA ENTRY - 2% • AUTH GUIDELINES NOT FOLLOWED - 1% • INCORRECT/MISSING COMMENT - 1% SOP NOT FOLLOWED • AUTHORIZATION ISSUE – 26% • UNDERPAYMENT – 16% • WRONG PROVIDER – 11% • SOP/GUIDELINE NOT FOLLOWED – 10% Addressing Incorrect Provider issues in Qnxt will reduce the Examiner Errors • As part of continuous improvement process, Firstsource provide feedback to the team on common examiner errors to improve accuracy levels.
  10. 10. Friday, December 9, 2022 Call Track Initiative
  11. 11. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 11 Call Track Volume Reduction Business Case & Problem Statement Call track volume has been around 2% and 45% of those are not adjusted today. Call track volume for the last 3 months are trending as follows. TX, OH and NY states contribute to 80% of the call tracks created. Around 70% of call tracks are from provider phone calls. Goal Statement • Reduce the not adjusted call tracks by 25% by end of Mar 2023 Project Benefit • Timely resolution of Member concern/First call resolution • Potential reduction in call volume • Cost reduction to Molina, approx. 10% Month Total Invoiced Adjusted % Adjusted Not adjusted % Not Adjusted Aug’22 12282 6761 55% 5521 45% Sep’22 10749 5933 55% 4816 45% Oct’22 12945 7282 56% 5663 44% It is important to identify the reasons for call tracks that are not adjusted in collaboration with the contact center team that creates these call tracks. Claims team spends good amount of time in reviewing these claims that do not get adjusted. This not only leads to delay in response to the customer but also impacts the customer satisfaction negatively. Project Time Lines Define 19th Dec 2022 Measure 6th Jan 2023 Analyse 30th Jan 2023 Improve 28th Feb 2023 Control 31st Mar 2023
  12. 12. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 12 Call Track Analysis – Not Adjusted Not Adjusted 44% Processed Correctly-61% No claim found-21% Sys Denial- 11% Sent to cost recovery-7% 1) Paid per contract(68%) 2) Corrected claim (11%) 3) Mod 26 required (8%) 4) No Auth (7%) 5) PAS claim with home health contract(6%) 1) No call track opened as no claim was attached to proceed 2) Sys message denial- Claim denied by system 3) COB payment with Medicare as primary Based on a sample of 150 call tracks, the team captured the reasons why a call track is not adjusted
  13. 13. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 13 WFM – Staffing Model & Best Practices Partnered with Vendor Management team to bring in efficient volume forecasting based on receipt trends and inputs from State specific stakeholders on the Molina side Vendor Management team has been of great support in enabling FirstSource with right data to right size the team and does help in planning in advance for any forthcoming volume changes Developed a robust skill set matrix to identify single point of failure and explore cross training opportunities based on volume mix change Demonstrated flexibility in deploying processors to any ad-hoc requirements or surge in inventory from a pool of cross trained resources to ensure timeliness Capacity alignment across states & LOBs are deftly handled to ensure seamless support
  14. 14. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 14 Molina Mailroom Operations
  15. 15. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 15 Mailroom Locations Long Beach, CA • Primary center for claims • Incoming source – USPS, Inter-office mail, FTE, Print • Averages 110k claims per month from across 19 states • Non-claims – identified and redirected to A&G sites • 55k Editor, BEI letters printed and sent out • Current headcount - 11 • Claims (KY) and A&G (FL, KY & VA) • Incoming source – USPS, FedEx • Averages 13K claims per month from KY • Average A&G 4K per month from FL, KY & VA • Current headcount - 5 Louisville, KY Salt Lake City / Chattanooga – CA, ID, UT, TX, NV, NM, SC, NY, OH, MI, WA, IL, MS …TBD
  16. 16. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 16 Long Beach Mailroom
  17. 17. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 17 Long Beach Mailroom: Claims Volumes • Firstsource took over the operations from Aug’21 onwards • Pre-Firstsource: Average claims volume per month trending at @91.5 K • Last 6 months: Average claims volume per month trending at @123K, which is 34% higher than the earlier • Reason for volume increase: Starting January 2022 additional states MA, NV, NY Medicare, VA are processed at Long Beach • Firstsource was able to absorb 34% higher volumes using current headcount through operational efficiency Audit Type Target Nov. 22 Mail Sort/Intake 99.00% 100.00% Batching/Inventory 99.00% 99.79% Scanning 99.00% 99.98% Rescan 99.00% 99.75% Overall 99.00% 99.86% Quality Performance
  18. 18. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 18 As is Process: • Molina Technology, equipment & facility Opportunity: • Move PO Boxes Firstsource Location Potential Savings: • Reduced cost and improved efficiencies Molina to Sympraxis As is Process: • Claims are scanned and sent to another vendor of Molina for Data Capture Opportunity: • Firstsource to take over data capture Potential Savings: • Agile processing, Improved auto adjudication rates with reduced cost Integrated Data Capture As is Process: • Non-Claims Identified in paper, No scan, Paper shipment to A&G Processing Locations Opportunity: • Identify non-claims, scan, triage, send digital image/data to A&G centers Potential Savings: • $508,000 p.a. postage charge, reduced cycle time Paper to Digital 02 03 01 Long Beach: Process Improvements Opportunities
  19. 19. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 19 LVL, KY Mailroom
  20. 20. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 20 A&G and Claims Volumes A&G Claims 5,200 3,900 4,900 3,300 4,600 0 1,000 2,000 3,000 4,000 5,000 6,000 Monday Tuesday Wednesday Thursday Friday Day of the Week Trend 2,500 5,900 4,400 4,500 4,800 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 July Aug Sep Oct Nov Paper and Email Total By Month 15,800 3,800 13,900 7,900 9,600 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 Monday Tuesday Wednesday Thursday Friday Day of the Week Trend 13,300 13,100 13000 11,600 10,500 11,000 11,500 12,000 12,500 13,000 13,500 Aug Sep Oct Nov KY ClaimsTotal By Month
  21. 21. © FIRSTSOURCE | CONFIDENTIAL I 9 December 2022 | 21 A&G/Claims TAT Report A&G Florida EXPEDITED APPEAL NON APPEAL SLA SUCCESS 44 7,291 365 100% SLA MISSED 0% Kentucky Virginia Total 82 11,626 710 100% 0% Kentucky Claims 27,222 23,777 50,999 100% 0% 20 18 3,072 1,263 284 61 100% 100% 0% 0%
  22. 22. © Firstsource Solutions Limited | Confidential | 09 December 2022 www.firstsource.com Helping customers stay ahead of the curve through transformational technologies and capabilities Firstsource Solutions Limited, an RP-Sanjiv Goenka Group company, is a leading provider of transformational solutions and services spanning the customer lifecycle across Healthcare, Banking and Financial Services, Communications, Media and Technology and other industries. Our ‘Digital First, Digital Now’ approach helps organizations reinvent operations and reimagine business models, enabling them to deliver moments that matter and build competitive advantage. With an established presence in the US, the UK, India and the Philippines, we act as a trusted growth partner for over 100 leading global brands, including several Fortune 500 and FTSE 100 companies.

×