End-to-End Digital Transformation of Inpatient Pre-Certification Process

The Medical field requires that companies within the industry be up to date with the latest workflow based intelligent BPM suite. It is important that while these companies stay up to date, they also stay within their allotted budget.

The implementation of complex business processes for all facets of the business – inpatient, outpatient, precertification, and discharge planning is crucial to the companies within this industry to optimize their abilities.

  • The Challenge

    An unreliable and inefficient legacy system for pre-certification of inpatients

    The client had a legacy system in place prior to Virtusa’s involvement that was flawed and needed to be overhauled.

    The new system needed:

    • Pega integration with multiple systems including XCLEYS, Auth Rules, Right Fax, Kaleidoscope etc.
    • Work in a very complex mixture of people from other vendors and FTEs
  • The Solution

    Completely modernized pre-certification process with differentiated capabilities

    Virtusa led teams (3) working directly with business to get the user stories finalized and built at a rapid rate with a low defect count.

    Virtusa has provided the solutions which included:

    • Coding of entire inpatient precertification  functionality within 5 weeks
    • Built the process in accordance with the Pega OOTB principles
    • Reused the HCIF and CMA to the maximum
    • Built the core components in the application such as the duplicate check, non-par process, workflow routing, XCELYS integration
    • Engaged with the business and IT to provide a solution based on OOTB functionality
  • The Benefit

    Improved inpatient admission time and satisfaction and increased operational efficiency

    Virtusa helped:

    • Complete the process way ahead of the original timeframe
    • Reduce time and increase RoI

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