The Situation
- Client was slow to communicate
- Desired novel affordability business rules were complex and tied multiple brands into one program
- Clients desired business rules required custom development that had not been executed in the industry
- Timeline to execute and complete testing was outside of client expectations
The Solution
- Creation of formal adjudication roadmap, including ensuring client objectives are outlined in plans
- Client visibility of new functionality to ensure they are aware of innovative capabilities
- Formal vendor management SOP
- Hired leader of vendor management to oversee EVERSANA support partners and ensure risk-mitigation and compliance are monitored
- Executed sub-contractor agreements that align to client’s expectations
The Results
- Faster turnaround time for execution of client business rules – most programs updated in 5 business days
- Client visibility to claim adjudication roadmap – able to share milestones with clients
- Updated service-level-agreements
Claim adjudication product roadmap creates new opportunities to optimize affordability programs.