Healthcare │ Artificial Intelligence
Providing Flexibility, Compliance in a Rapidly Changing Healthcare Market
Plan de Bienestar UTM-PRSSA, a medical insurance and healthcare provider, partnered with Wovenware to transform its outdated Referral Management System, achieving greater efficiency, compliance with regulatory requirements, and improved on-time payments.
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“With Plan de Bienestar and Wovenware working together, this innovative system is poised to revolutionize how organizations manage their well-being programs, ensuring they stay ahead of the curve in an ever-changing landscape.”
Healthcare │ Artificial Intelligence
Modernizing Solutions Together
In the dynamic and highly regulated landscape of today's healthcare industry, the ability to adapt to evolving market demands is paramount for service providers and insurers. Plan de Bienestar UTM-PRSSA, a dedicated medical insurance and healthcare provider serving Puerto Rico's port workers, faced a critical need to replace its outdated and rigid Referral Management System.
Plan de Bienestar and Wovenware Forge a Path to Innovation
To address these pressing issues, Plan de Bienestar partnered with Wovenware, resulting in the creation of a flexible and adaptable system. This modern solution is not only capable of seamless updates and the integration of new functionalities and modules but also offers robust capabilities in billing, referral management, and reporting.
Challenges and Learnings
Plan de Bienestar UTM-PRSSA faced significant challenges due to its outdated Referral Management System:
• Outdated System: The legacy system was inflexible and couldn't adapt to industry changes.
• Manual Processes and Delays: Manual workarounds led to errors and payment delays of up to 3-6 months.
• Billing, Reporting, and Regulatory Complexity: Managing billing, reporting, and complying with healthcare regulations was challenging.
• Scalability: Adapting to changing market dynamics required a more scalable system.
• Affordable Care Act Compliance: Meeting preventative care deductibles under the Affordable Care Act added complexity.
The Wovenware Approach
The Wovenware team orchestrated critical enhancements to replace the constraints of the outdated legacy system. With an agile architecture at its core, the newly implemented system not only met the immediate needs but also laid the foundation for ongoing enhancements. It empowered Plan de Bienestar to incorporate new functionalities and modules as the healthcare landscape continued to evolve, ensuring the organization remained at the forefront of industry innovation. This collaborative effort between Plan de Bienestar and Wovenware not only addressed the insurer's pressing challenges but also set a precedent for adaptability and resilience, enabling the company to thrive well into the future.
Technologies we take advantage of
Agile
Building it Right
The upgraded Referrals Management System at Plan de Bienestar brings several key improvements:
- Provider Management: The system handles provider registration and upkeep seamlessly, streamlining administrative tasks and maintaining a robust network of medical professionals.
- Enhanced Reporting: Plan de Bienestar now has access to a wide range of new reports, including member and provider expense reports for better financial insights, as well as general statistical reports for data-driven decision-making.
- Eligibility Determination: The system includes eligibility file processing, allowing quick and precise determination of eligibility for third-party entities, simplifying interactions with external partners.
- Efficient Claims Processing: The system now efficiently manages claim processing files, making reimbursement processes smoother and improving provider relations.
Let’s create useful technology together that empowers humans and delivers impact.