Not so long ago the Claims department at Texas Children’s Health Plan faced significant challenges. Those challenges led to unhappy providers and millions of dollars in state penalties. But in the last year April Riggs, director of Claims Administration – and her newly restructured team – have overseen a remarkable turnaround. The team is more efficient, providers are happier and within the last eight months, the department has incurred $0 in state penalties.
Remarkable is perhaps an understatement.
In record time, the team has:
- Ensured that 98 percent of all claims are paid within 30 days.
- They reduced the average time from 22 days to five days.
- Reduced the amount of claims in cue.
- The team had 80,000 claims in cue at their lowest performance level.
- The goal was to be at less than 30,000 claims in cue, which they have achieved and sustained for 14 months.
- Eliminated liquidated damages, which are non-compliance penalties issued by the state.
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- The department previously incurred $2 million in damages over a 21- month period.
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- For the past eight months, they have incurred NO new liquidated damages.
How did they do it?
“We coined our mission Mission Possible and we set some very straight forward goals,” said Riggs. “We knew that to be successful we had to define our mission, review historical practices and in no way could we return to business as usual.”
Riggs immediately set her team on a course that consisted of:
- Putting the right people in the right positions
- Making data driven decisions
- Implementing metrics that matter
- Consistently monitoring productivity; and
- Collaborating with key business partners
After all of these efforts were in place, she noticed a shift occurring within her team. “It was a pleasure to watch it happen. We became a team that could identify issues very early on and then move swiftly to identify solutions.”
And if that wasn’t enough, Riggs said her staff began daily briefings to review their work for the day, the week and even for the following week. “I believe Mr. Wallace calls that skating to where the puck is going to be,” she said.
Indeed it is.