Provider bulk TIN matching – IRS TIN matching is a regulatory process that provider networks team needs to maintain and it is essential for the year ending 1099 processes. However the challenge there was that FACETS does not have a place holder to identify whether TIN matching is done for the provider and even if it is placed as an attachment or note in provider record, any update to provider record, it does not carry over to changed record. We have experience in automating this process for multiple large blues plan where created the complete automation of generating the provider file needed by IRS and sending it over to IRS, and once the response is back from IRS, created the necessary XPF process to update the provider record in an attachment field to maintain the date of the TIN match. We also implemented a trigger mechanism to carry over the TIN match date to updated record if there are any changes to the provider by any other processes.
Automated FEE Schedule maintenance – Fee Schedule maintenance using FACETS / NetworX is a complex process due to the sensitivity and complex data structure of NetworX tables. Moreover multiple data source and multiple data formats such as Medi-span, HIAA, DenteMax, Medicare, AWP, RVU etc. make it more difficult and cumbersome. Our folks have automated the Fee Schedule load and maintenance process for clients like Pacific Source and BCBSRI and standardized the Fee Schedule intake process for all monthly, quarterly, six-monthly and yearly process. We built a scalable Fee Schedule load process where adding new Fee Schedule needed very minimal changes, reduced manual intervention and established efficient logging and error handling process.