Focused expertise yields unparalleled results

A Medicaid Managed Behavioral Health Plan was experiencing severe information systems problems and could no longer meet state data processing requirements for encounter reporting. The plan selected a replacement system, but had not yet developed an implementation plan when they asked Oleen Pinnacle to provide project management and implementation assistance.

The health plan purchased the system with the expectation that it would be implemented in three months. Within the first week Oleen Pinnacle’s project manager developed a preliminary implementation plan with the client agreeing that it would take at least six months to implement — if everything went well. In six months and two weeks the system was live and certified by the state. Within the next four months all of the claims from the previous two years had been reprocessed with a 97% acceptance rate. Without Oleen Pinnacle having detailed knowledge of the vendor’s system, the plan’s business processes, and the business of Medicaid this could never have happened.

In a concurrent project, over a twelve month period Oleen Pinnacle implemented an encounter submission and adjudication reporting system that provides detailed reports back to providers on encounters that fail to meet processing requirements. Encounters can now be tracked from receipt to final acceptance even when they are returned for correction and reprocessing. This has helped to improve provider relations and greatly improved the quality of data input by the provider.