Large Scale Insurance Implementation

As my colleague Anthony and I boarded the flight to New Jersey on September 30th 2006 the mood was a mixture of apprehension and excitement. The story began back in March of 2006 when Delta Dental of New Jersey (DDNJ) had selected DSI as their development partner to help make their vision of a new benefits management system, which would replace their existing legacy application, a reality. DDNJ is a leading dental benefits administrator with more than 35 years of claims and benefit management experience, providing coverage to more than 2,000 groups, 1.7 million members, and 12,000 dentists. It provides coverage via commercial, school board, and government programs and this was to be their biggest solutions venture in 15 years.

The early selection process certainly gave me a lot of confidence that the two companies could work together when I witnessed the efficiency with which each and every stage had been planned and executed. When a date was given for a decision it was kept, when a document was issued it was meticulous and when we met face to face the expectations were realistic, mixed with the right amount of humour (not forgetting the green soda bread on Patrick’s day).

After DSI was selected to partner on this implementation with NJ, we spent three weeks on site looking at requirements, developing the implementation framework and addressing the all important time and cost structure. The result of this work received unanimous approval from the DDNJ board to progress with the recommendation and have this new system operational in 16 months.

Now the real work started. DSI assembled a team of about 20 technical staff including developers, DBA’s, architects and project management, all of whom had many years of experience in the benefits management and development arena. DDNJ supplied all the subject matter expertise, internal project management, testing resources and infrastructure staff. As DDNJ had decided to customise a system that DSI had previously built, experience on this platform was essential.

The [tag]Microsoft[/tag] [tag].NET 3.0[/tag] based [tag]benefits management system[/tag] was built to support all aspects of DDNJ’s business from member maintenance to real-time claims.

The key components included:

  • Entity Management System to maintain group, member, benefit and financial information.
  • Real-time [tag]Claims Adjudication[/tag] and Workflow system.
  • A comprehensive suite of [tag]Customer Service Applications[/tag].
  • Efficient Provider and [tag]Fee Maintenance system[/tag].
  • Online and [tag]Electronic Eligibility processing[/tag].
  • Billing and Payment systems.
  • A suite of Web Services that integrate with both customer service and external third-party applications including OCR, IVR and real-time claims.
  • A broad range of Customisable Online Reports

The application was designed to focus on maximising efficiency including drop to pay, real-time claims processing, customer service queries, payment, and billing.

In short this system was now going to run DDNJ’s business and determine its operational efficiencies for many years to come. After 16 months of daily meetings, hundreds of use cases, thousands of test cases and a little over two million lines of code, the question on everyone’s lips was, were we ready?

Though there is always an element of risk associated with such a large launch or “big bang” as many in the industry refer to it, my confidence level was high for a few simple reasons. The advantage of going with a proven platform gave NJ the opportunity to test a lot of functionality from the outset, this also provided them with the advantage of commencing training earlier than is possible with a complete new build, which more often than not will prove to be the Achilles heel come launch time when users are dealing with increased volume and new processes. This, in itself, is a very efficient way to test the application outside of the formal system and UAT process. Also, conversion of legacy data had commenced day one and within three months DDNJ were able to see subsets of their own data on the new application but more importantly, was the fact that six months before launch, we were able to compare the results from large batchs of claims processed on the legacy system to the exact same batch processed on the new system and do byte for byte comparisons of the results.

For me this kind of parallel testing is an essential component when it comes to talking about percentage completion, confidence factors and launch dates. Unless you are changing how you process claims which is most unlikely (by and large you want to just process them more efficiently) you will want to process maximums, deductibles, step therapy, history cross check, co-ordination of benefits and so on in much the same way as you always have, concentrating on the amount paid.

In DDNJ’s case, with two months to go we had achieved 93% accuracy for batches of ten thousand plus claims between old and new. The reason this is so important is that during this process you are not only testing the claims adjudication application but everything that came before it. If provider, membership, benefits, fees, eligibility or any other part of the workflow has issues these will be highlighted when the claim is processed.

So knowing that we had strong numeric data supporting the accuracy of the new system, many months of training on the user side, positive results from infrastructure with regard to stability and performance, a track record of quick turnarounds from development when issues arose, a solid base of super-users who could mentor and fire fight production issues and a senior management team who were intimately involved with every aspect of the project the decision was made to launch.

So Anthony and I arrived on site on Sunday afternoon to the news that the four day conversion process had completed and the system was in its final stages of testing for launch the following morning at 7am. The next day came and ICE was launched and to everyone’s delight proved to be as stable and accurate in production as hoped for. Were there issues, of course there were but none that could not be assessed and remedied within a reasonable timeframe. The planning had paid off and for every issue encountered a subsequent workaround or fix was applied to ensure that DDNJ’s business continued to operate. The first checks were issued one week later and feedback from the provider community suggested a seamless cutover.

Many efficiencies have been achieved since launch, with scope for many more based on a system, which is flexible and easily enhanced to react to an ever changing business environment. And what of the relationship between DSI and DDNJ, well the following statement sums it up when asked to comment on how we worked together:

“We needed an enterprise claims and benefit management system to provide coverage for our 1.7 million members. Choosing to go with a customized DSI dental insurance application meant our concerns about scalability and large volume batch processing were minimized. Taking just under 18 months to implement, DSI brought their solid project management expertise and technical knowledge to the fore on this highly successful implementation”.
-Bruce Silverman, Senior VP Claims & Customer Service, Delta Dental of New Jersey.

DSI and DDNJ continue to work together on enhancements or new projects but the same processes and procedures that enabled a successful launch apply today. Communication is ongoing on a daily basis, advantage is taken of the time difference between the two companies to maximise the working day and planning is at the forefront of any activity ensuring the realism and professionalism which provided this relationship with such a solid foundation continues into the future.

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