Virtusa’s product engineering and innovation expertise ensures your organization gets the best out of Pega SCE
- Cognitive Computing and Machine Learning: Payers can offer personalized solutions for everyday consumers.
- Blockchain: Helps in reducing red tape, increasing interoperability, and improving consumer relationships within the healthcare payer community.
- Analytics: Improve patient satisfaction and patient flow, reduce avoidable readmissions, and adverse events.
- Microservices: Create new ways to connect and engage with patients.
- Everything-as-a-service: Combination of data science, mobile applications and big data to manage chronic diseases, reduce cost, and increase reach of healthcare.
With Pega SCE, your organization benefits from enhanced straight through processing, transparency and visibility, and business flexibility.
Straight through processing (STP)
Reduces the overall per-claim processing cost and improves operational efficiency. It also lays the foundation for processing potential point-of-care, real-time submissions in the future.
Transparency and visibility
Increases engagement and provides claims operations users and policy managers with a sense of ownership of the adjudication system that results in active contributions to continuous improvement.
Business flexibility
Optimizes network contracts by enabling appropriate reimbursements and improving implementation plans for upcoming regulations. Also, it helps teams avoid repetitive, low-value tasks and focus on higher-value work effort.
Virtusa’s Pega SCE is a platform that uses cognitive computing and machine learning to replace legacy claims platforms to improve straight-through processing, transparency and visibility, and business flexibility. The platform deploys a process-oriented solution to help companies move away from rigid and inflexible systems, high operational costs, and poor user experience.
Virtusa’s product engineering and innovation expertise ensure your organization gets the best out of Pega SCE. The platform helps streamline claims modernization with the following features:
- Cognitive computing and machine learning: Payers can offer personalized solutions for everyday consumers.
- Blockchain: Helps reduce red tape, increase interoperability, and improve consumer relationships within the healthcare payer community.
- Analytics: Improve patient satisfaction and patient flow, reduce avoidable readmissions and adverse events.
- Microservices: Create new ways to connect and engage with patients.
- Everything-as-a-Service: Combination of data science, mobile applications, and big data to manage chronic diseases, reduce cost, and increase the reach of healthcare.
Virtusa’s Pega SCE provides additional applications to the payer’s claims processing system to streamline workflow. The benefits of Pega SCE include:
- Easily configurable next-gen claims platform
- Cost efficiency
- Optimized business processes
- Guided and automated workflows
- Superior user experience
- 24 hours a day – 8371/P/D processing, approximately 12 8371/P/D files processed daily
- 92% improved first-pass rate – medical
- 80% improved first-pass rate – outpatient
- 55% improved first-pass rate – inpatient
- >25,000 claims pre-adjudicated/hour
Additional benefits include:
- Straight-through processing (STP): Reduces the overall per-claim processing cost and improves operational efficiency. It also lays the foundation for processing potential point-of-care, real-time submissions in the future.
- Transparency and visibility: Increases engagement and provides claims operations users and policy managers with a sense of ownership of the adjudication systems, resulting in active contributions to continuous improvement.
- Business flexibility: Optimizes network contracts by enabling appropriate reimbursements and improving implementation plans for upcoming regulations. Also, it helps teams avoid repetitive, low-value tasks and focus on higher-value work efforts.
Virtusa’s Pega SCE guides clients through a complete journey of the claims modernization process. Your organization will benefit from simplified workflow and business flexibility by following the Pega SCE journey:
1. Discover
- Current state assessment
- Financial business case
- Obsolescence review
- Define overall roadmap
2. Strategize
- Vision and objectives
- Focus areas and KPIs
- Define implementation plan
3. Design
- Refine requirements
- Define end-state architecture
- Futuristic design
4. Build
- Build smart-modularization simplified
- Execute SIT and UAT
- CICD Pipeline
5. Go-Live
- Support service automation
- ‘Plan for change’ service