Training

training HCT provides training professionals and resources to prepare you for the challenges you will face in the rapidly evolving healthcare industry.
First-Pass Rate Optimization

The first-pass rate optimization process reduces the number of claims that require user involvement, reducing time, workload  and cost associated with claims adjudication. Our consultants leverage their extensive claim processing experience providing claim processing solutions to large payers.

Client:

A large state wide health plan of a payer company

Project Definition:

Improve the first-pass rate of front-end edits for the client's claims processing system

Project Complexities/Deliverable:

  • Develop a comprehensive blueprint of the front-end system
  • Develop a matrix to identify and classify all edits
  • Inventory business rules and relevant program logic for all edits
  • Monitor and record system performance in the production environment, and extrapolate edit failure frequency
  • Develop edit frequency reports and identify high impact edits
  • Make system modifications to address impediments

Project Technologies:

  • IBM S/390
  • CICS
  • COBOL
  • DB2
  • EZTRIEVE PLUS
  • JCL
  • VSAM