BenefitPro™
Complete Solution for Benefit Configuration Testing

Technology

• Microsoft .Net Web API
• Angular Js
• Supports SQL Server, Sybase and Oracle
• Easy installation and integration to
Intranet
• Role based security

BenefitProTM is a complete benefit configuration testing automation solution designed and developed by our healthcare team based on their real-world experience of the past 10 years in benefit configuration testing

OVERVIEW

Every year, health plans configure new benefit plans or revalidate existing plans to offer the best coverage and care to their members. This is a very critical and time sensitive effort to accurately design benefit plans and test them on time to meet the open enrollment or enrollment renewal timelines. Any delay in this effort may impact thousands of members, their families and cause a huge dent on the positive consumer experience. The intensity and volume of this effort peaks before the open enrollment period in October. Many health plans employ hundreds of temporary resources during this period to complete the benefit testing on time for open enrollment. “BenefitProTM saves health plan testing budgets hundreds of thousands of dollars while offering a stress free Open Enrollment.” 

Due to this largely manual effort, the testing cycle, defect fix and retesting becomes very cumbersome and error prone, often leading to delay or a longer open enrollment period. This impacts the member experience as well as diminishes employee morale. The BenefitProTM automates this process and reduces the overall effort to validate the accuracy of all benefit plans, while maintaining higher and better quality testing. This enables the configuration team and testers to assess and retest fixes more efficiently. BenefitProTM saves health plan testing budgets thousands of dollars while delivering higher efficiency.

The Benefits testing tool was designed and developed by our core health care team based on their real-world experience over the past 10 years involving benefit testing. This easy to use web interface was built from the ground up based on extensive feedback from testing teams across various health plans. The testing tool is rooted in three basic principles of benefit configuration validation:

• A comparison between the offered benefits and the configured benefits at the service    level.
• Validation of preauthorization, limit and deductible that compares offered vs configured values.
• Claim level validation ensuring proper provider reimbursement and member liability.

 

 FEATURES

The salient features of the tool are –

  • Benefit validation simplified to service level granularity.
  •  Ability to test only the changes for renewal products with minor changes in benefits.
  • Ability to choose a service category like physician, hospital services or individual services like chemo or LAB in different settings.
  • Easy retesting with the ability to select only fixed services.
  • Product can be assigned to multiple testers based on categories which improve productivity.
  • Efficient comparison between benefit artifacts vs what is configured in Trizetto Facets.
  • Setup of benchmark claims at service level, which eliminates the repetitive process of coming up with claims for each testing cycle.
  • Automatically generates claims XC keyword to be loaded in Trizetto Facets.

 

Tool provides ability to use Predefined Benchmark claims which eliminates researching Claims for every Line of Business / Product. Provides easy User Interface for adding and modifying Benchmark claims. It performs auto comparison between Claims and Benefits which eliminates manual intervention and improves Product Turnaround time.

Interactive Testing reports facilitate easy decision support system. The tool generates pass fail ratio at project level, various comparison and historical reports to provide the holistic status of the testing projects.

If you like to know more about Benefit Testing Tool, our sales team will be very happy to provide a demo of the product at your office. If you need any customization to the product to suit your business need, our analysts and developers will work with you in getting that done

We will also provide product administration and user training. For more details email –  sales@agilehealthtech.com