GTEC Andrew Yorke President & CEO Manitoba Blue Cross

Transcription

1 GTEC Andrew Yorke President & CEO Manitoba Blue Cross

2 Background on the Two Strategic Partners Manitoba Insured Benefits Branch Manitoba Blue Cross Joint Claims System Project Scope Timeframes Budget Project Plan 2

3 Manitoba Health Insured Benefits Branch Insured Benefits Branch administers: Medical Program Inter-Provincial Reciprocal Agreements Hospital Abstract Program Out-of-Province Benefits and the Transportation Subsidy Program Audit and Investigations and Third Party Liability Medical claims program includes four key processes: Registration and Client Services Claims Coding and Assessment, Data Entry and Practitioner Registry Complex Claims Out-of-Province, Hospital Claims and Reciprocal Agreements. 3

4 Insured Benefits Branch Claims Processing Claim Creation Claims Processing Patient Eligibility Edits Exclusions Assessments Assessments Premiums Location of Service Interest Out-of-Province Claims Retroactive Payments Laboratory Fees Cap Claims Payment File to Practitioners 4

5 Insured Benefits Branch Business Case for IT Modernization Claims Processing Aging legacy system Growth in exceptions will result in one third of IBB work becoming manual within 5 years. This will increase costs of delivery and impact significantly on service to physicians and citizens. Increased claim growth due to the aging of the population will make these trends even more dramatic. 5

6 Manitoba Blue Cross Manitoba Blue Cross (MBC) operates several independent lines of business with different delivery channels: MBC also supports Life coverage in partnership with all Canadian Blue Cross Plans. 6

7 Manitoba Blue Cross MBCs core business processes are organized as follows: Adjudication Administration Benefit Calculation Claims Auditing Claims Disposition Claims Management Communications Initial Setup (Master Data) Payment Management Receive Claim Reporting and Data Management 7

8 Manitoba Blue Cross MBC has an extensive coverage model consistent with most North American Insurers Benefit Type Trees contain Benefit Types 8 Requirement to be able to tailor and mass customize plans is a critical strategic element of MBC s business model.

9 Manitoba Blue Cross Claim Processing Legacy solution requires updating and is beginning to impact current business model. New solution creates a number of opportunities: Cost efficiencies created from process and system standardization. Growth benefits created from ability to offer new and innovative products to customers. General improvement in technology infrastructure will create a competitive advantage for Blue Cross in marketplace. 9

10 Why SAP Joint Claims System Project? Manitoba has an SAP First Policy in place through the Treasury Board. To support this policy, MB has a capacity license with SAP. Broad access to SAP software and industry solutions. Incorporates all Government Organizations and Entities. 10

11 Why SAP? 11

12 Why SAP? 12

13 Project Objectives To build and implement a SAP based Claims Processing System that provides the basis for improved claims processing capabilities for Manitoba Health and Manitoba Blue Cross by leveraging leading edge technology and business practices by the end of the first quarter of To transform business processes in both MBC and Manitoba Health to ensure faster service to clients, less manual processing of claims, more efficient processing for staff and a secure claims processing solution for the future of both organizations. To create a Single Instance with separate clients. To utilize a common infrastructure. 13

14 Project Objectives To establish a long term, strategic partnership between Manitoba and MBC that will maintain leading edge technology well into the future and ensure the sustainability of the CPS to the benefit of both organizations. By the end of Blueprinting, Manitoba Blue Cross will establish an appropriate support relationship with SAP in conjunction with the Manitoba Government. 14

15 Cost economies Expected Benefits MBC and Manitoba will split the build and support costs to significantly reduce each others project and support costs over time. This project will dramatically reduce the future need for Manitoba to make capital investments in IBB operations. Provides a basis for improved claims processing capabilities by leveraging leading edge technology and business practices. MBC will manage the delivery of the SAP claims system on behalf of Manitoba. The risk of technology obsolescence will be mitigated by implementing the SAP claims system due to SAP s ongoing development, support and breadth of capabilities. 15

16 Expected Benefits MBC will bring its private sector experience in managing claims to bear and help improve future state claims processes to the benefit of both Manitoba and MBC. Create significant system capacity to allow for rapid deployment of new products, movement into new markets or the development of new services. The potential to quickly add other customer, lines or business or geographic regions with only marginal increase to fixed costs. Increase agility to meet emerging needs of new and existing customers. 16

17 The Joint Claims Solution 17

18 The Joint Claims Solution 18

19 The Joint Claims Solution Receive & Enter Claim Adjudicate Claim Create Payment Approve Payment Issue Payment Post GL Claims Management Payment Management Business Partner Management (Providers, Subscribers, Groups, Etc ) Coverage Management Form / Letter Generation Reporting Security and Auditing 19

20 Project Approach governance Review with Change OCM Analysis and Review Board Planning Procurement and environment set-up Review with Change Review Board 20

21 Project Timeline 21

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