Case Studies

Care1st Health Plan Arizona

Overview


Care1st Health Plan Arizona, a Phoenix-based payer who provides healthcare coverage to beneficiaries of the Arizona Health Care Cost Containment System (AHCCCS) sought ways to improve how they imported data into their core system. A recent expansion into Pima County from Maricopa County took Care1st from an enrollment of roughly 50,000 to over 70,000 individuals virtually overnight. Line-of-business records, provider panels, and other records had to be added or updated quickly to ensure continuity of coverage and reimburse providers. Additionally, as a newly-named Third Party Administrator (TPA) for Arizona’s insurance cooperative offered through the new National Health Insurance Marketplace (part of the 2010 Patient Protection and Affordable Care Act, or PPACA), the organization was preparing to handle potentially thousands of new enrollees and provider records over the coming months. In order to expedite this data entry, and reduce the need for frustrating macros, Care1st Health Plan Arizona turned to EnableSoft’s Foxtrot® Automated Employee™ to automate the process.


The Challenge


The expansion by Care1st Health Plan Arizona into Pima County brought with it the prospect of adding data on Pima County’s health care providers across each of their lines of business. Panel sizes (essentially the maximum number of patients a provider could serve in a given timeframe), eligibility information, fee schedules, primary care physician designations, and more, had to be added or verified for every new provider they covered to ensure future claims would be paid. The demand from new Marketplace enrollees meant thousands of individuals would be added, and tens of thousands of provider records would be updated, by the end of the first quarter. Add to all of this routine tasks like reprocessing claims, approving claims, and updating NDC codes, and the payer had a mountain of data to maintain.

The organization traditionally has employed up to 15 different macros per day to perform large data entry and maintenance tasks like this, but they were unreliable. “Our macros would stop and start at random. We needed someone to sit and watch the macros to restart them once they broke. It was inefficient.” said Ivy Boyer, Manager of Business Application Systems at Care1st Health Plan Arizona. Care1st would often turn to their small provider data management team to manually enter smaller jobs of less than 200 records. This meant pulling these individuals away from their daily work, maintaining the provider network and addressing claims backflow, to complete the data entry.

Return on Innovation (ROI)


After a thorough search, Care1st Health Plan Arizona selected Foxtrot software from EnableSoft to replace their inefficient macros and automatically execute the multiple data-related tasks that cost them time and productivity. In Foxtrot, Care1st hired an “Automated Employee” who handles virtually anything their current employees perform with a mouse and keyboard, but with better speed and accuracy. “Normally, it would take us an hour or more to process 1,000 records with a macro. Foxtrot does it in a few minutes with no babysitting.” explained Boyer.

  • Boyer and her team were up and running quickly, automating routine tasks even before the three-hour basic training that was included with their investment. Foxtrot’s Smart Scripting technology makes it easy for anyone to write and execute scripts in the presentation layer of almost any application. Among Boyer’s recent wins with Foxtrot
  • Marketplace provider data: More than 43,000 provider records have been updated automatically, without macros or manual entry.
  • Updating physician panel sizes: A task that took between and 8 and 10 hours with a macro is now done in 1 hour.
  • Reprocessing claims: Macros were able to process 5,000 claims at a rate of 5 per minute across 4 sessions. With Foxtrot, each claim is processed in seconds with total accuracy.
  • Approving claims: Foxtrot now automatically approves up to 20 claims per minute, versus 3 claims per minute with a macro.
  • Updating NDC codes: Previously handled manually or with clunky macros, Foxtrot recently added 1,100 NDC codes in just 1 minute for Care1st Health Plan Arizona.

Care1st Health Plan Arizona and Ivy Boyer continue to find new ways to employ Foxtrot in their operation. In doing so, they’re introducing new efficiencies and opportunities for productivity along the way. “Part of my job includes finding new ways to help our company increase efficiencies and reach our business goals.” said Boyer. “We’ve already been able to automate a number of tasks and do that. But, we’ve only scratched the surface of what Foxtrot can do. I’m excited to see where we can take the technology from here.”

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