Projects/Client Solutions

NCPDP Accelerator
The Challenge: New legislation mandated a client accept and pay NCPDP pharmacy claim transactions or face per-transaction fines.
The Solution: Methodical developed a system that utilized inbound and outbound data formats to store, transform, and process claims without redeveloping the main claims processes system.
The Return: Cost and time savings thanks to developing around the main claims processing engine.

Pharmacy Benefits Management Analysis
The Challenge: The client had 10 weeks to analyze system impacts and process changes before selecting a new Pharmacy Benefits Management (PBM) partner.
The Solution: Methodical analyzed current claims processing operations from current to a possible future state and delivered detailed IT specification documents on time and within budget.
The Return: The client was able to meet its goal of integrating a new PBM partner on schedule.

Pharmacy Benefits Management (PMB) Implementation
The Challenge: The client needed to replace a 15-year Pharmacy Benefits Management (PBM) without any disruption to the existing claims payment process.
The Solution: Over 10 months, Methodical implemented a meticulous SDLC to redevelop the claims processing system, ancillary systems, and workflow functionality.
The Return: There were no disruptions to the existing system and the implementation went so smoothly, most system users did not realize the PBM switch had occurred.

EDI and NCPDP Training
The Challenge: The client needed to train/retrain existing technical staff in Electronic Data interchange and NCPDP system processing specific to the client’s proprietary system.
The Solution: Methodical performed a systems analysis to identify scope, and rolled out a two-week proprietary training program specific to the client’s business processes and systems workflow.
The Return: The client met its objective and course reviewers gave the training class such high marks that it was repeated.

OCR Systems Analysis
The Challenge: The client wanted to leverage its Optical Character Recognition (OCR) claims scanning process to its full potential within the agency.
The Solution: Methodical’s analysis, conducted in 45 days, provided a detailed report of personnel duties aligned to internal processes, hardware settings, software configuration, workflow re-engineering, and industry best practices.
The Return: The report was so valuable that the client has implemented most of the changes advised.

HIPAA 5010 D.0 NCPDP Gap Analysis
The Challenge: The client wanted a Gap Analysis of the current HIPAA 4010 system processing vs. the mandated HIPAA 5010 legislation so that it could test the new system by January of 2011 and implement by January of 2012.
The Solution: Methodical created pre-prepared information workbooks utilized in JAD sessions to turbo-charge the analysis and fact-finding process so it could be completed in five months.
The Return: The implementation team had a roadmap that included detailed business requirements and technology specifications so it could meet its deadlines.

CMS Payment Methodology
The Challenge: The client needed to Gap the difference between the existing payment methods and the Centers for Medicare and Medicaid Services (CMS) payment methods. A critical mid-project change collapsed the deadline by 30 percent.
The Solution: Methodical produced a two-volume, 350-page set of specifics within four months that architected and compared CMS pre-processing decision logic, multiple CMS payment methods and an Industry Sample Solution to the existing payment method.
The Return: The client met its internal deadline and had the information to support mission-critical implementation decisions thanks to Methodical’s quick reaction time to add resources.

Recovery Audit Analysis
The Challenge: The client was dissatisfied with its existing homegrown software and lack of software documentation available in the claim recovery audit process.
The Solution: Methodical decomposed the existing software modules and created the requirements specifications needed to build a new software application.
The Return: The client’s technical staff was armed with the information needed to easily develop and implement a new software application thanks to the detailed requirements.

Payment Processing Refactoring Analysis
The Challenge: The client was receiving numerous complaints from its nationally-distributed user population regarding severe degradation in the payment processing system.
The Solution: Methodical conducted a refactoring analysis to provide the client with the necessary technical specifications to improve the system architecture and design.
The Return: The client’s technical staff experienced tremendous improvements in system performance and user productivity.

EDI Optimization & Tracking\Auto- Vendor Selection
The Challenge: The client wanted to reduce the time-consuming manual matching of incoming claims to vendor records, necessary for correct pricing, in the client database.
The Solution: Methodical conducted discovery sessions to identify the commercial business rules engine, legacy software needs, and other requirements, and developed a web service that included tracking discrepant business partner data.
The Return: The client’s goal to reduce pricing processing time was exceeded.

Medispan Audit
The Challenge: The client wanted to audit Medispan drug prices charged by trading partners per contract agreements.
The Solution: Methodical created a system consisting of background processes, a database, connection to legacy systems, and a web application that applied Medispan data to trading partner claims and offered multiple query mechanisms.
The Return: The client’s goal was met and statistics such as over/under charging by date range can now be obtained.

Online Web Application
The Challenge: The client wanted a web application that would enable dependents and beneficiaries to submit online applications and add/update other health insurance information. Requirements were specific, including replicating pre-approved paper applications.
The Solution: Methodical worked closely with business, management and technology teams to create requirements and high level wire-frame designs for the proposed new application.
The Return: The client has detailed specifications for building the required application.

Recently Awarded and In-Process Projects:

  • CMS Medicare Crossover COB Parts A, B, and D Implementation
  • Medispan Drug Database Implementation
  • e-Pharmacy Implementation
  • Multi-Ingredient Compound Pharmacy Claims Processing Implementation
  • Service Line Level Adjudication Redevelopment Project Management
  • ICD-10 Requirements Analysis HIPAA 5010 \ D.0 Implementation
  • Graphical User Interface (GUI) Requirements Design and implementation for Electronic Data Interchange (EDI) systems
  • Hibernate Technology Conversion Implementation