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Implementation
It is no secret that a system as powerful as IMPACT requires more than a little attention to set it up correctly. At MCSI we have concluded that the implementation process can be successful only when performed as a true joint effort between the software developers and the customers expert staff.
 MCSI uses a proto-type style of development and implementation. We make changes to the system concurrent with reviewing these changes with the customer. This allows the customer to see the effect of their wishes and make adjustments where necessary. All of our customers have grown to appreciate this style of implementation and would be very disheartened to return to the "spec and code" methodology - that typically takes weeks to accomplish what we do in hours.
You're probably wondering how we would manage the implementation of a large installation. Here's a typical schedule that we prepared as the first step in one of our installations a few years ago. It uses Excel but we have since reverted to MS Project:
Click here to see a Typical Implementation Plan (Excel)
- IMPACT Master File Generation
The IMPACT system requires the presence of a variety of master files before it can properly process claims. Building these master files manually or converting them from another system is the first step toward successful implementation.
Different types of users will require different sets of master files. As an example, if you are a TPA you will probably need to set up Plan Definition records to define your plan benefits. If you are a PPO, Plan Definition files may be unnecessary.
The sequence in which these files are generated also depends on your type of business. For example, TPA’s usually start by building the Plan Definition files while PPO’s usually start by building the Client files. Whether these files are created manually or converted from an electronic source also plays a part in scheduling this process.
The following paragraphs identify the major master files used by IMPACT. This document could be used as a checklist to track your data acquisition progress.
1. User Control Record Data
Each of your users will have a record within IMPACT that controls their sign-on, password, security level and other controlling data. These records should be set up immediately to enable your operators to enter the system under their proper identities.
2. Client Master File Data.
The term “client” refers to both payers and employer groups. Each payer, group, division, department, etc. must have a master demographic record and pertinent related records that identify the networks and products that apply to each client. Note: before you generate these files, you should consult with MCSI to establish a client/network/product/carrier/plan coding structure that makes sense for your business.
If you expect to receive periodic enrollment data from employer groups on paper, and you would benefit from the IMPACT automatic enrollment feature, Client Cafeteria records may also be created.
3. Member Master File Data
Member data is not always required. If you are a PPO and are re-pricing claims that do not need eligibility, you may choose not to populate member and enrollment information. However, if you will be adjudicating claims, you probably need to populate the member master file with appropriate enrollment data. Large member databases are usually populated via downloads from the payer or group or converted from another system.
The Accumulator file will be required only if you will be adjudicating claims and you are starting the IMPACT system in the middle of a plan year or if your plans contain life time benefits. This file contains the accumulated totals of each benefit paid to each member. This is one of the more difficult files to convert from one system to another due to the various methods of storing this data in differing systems. If claim history is being converted, it may be possible to generate these files by re-adjudicating the claims in the history file.
Some relational files to the enrollment system may be associated with Care Management functions. If so, records may be needed in these files to identify individuals that qualify for modified benefits, such as a person at risk of breast cancer or other specific pre-existing conditions.
4. Plan Definition Data
If you will be adjudicating claims (as opposed to just re-pricing them), each plan of benefits must be defined in the IMPACT Plan Definition subsystem.
In addition, the logic that identifies which services fall within each benefit must be created in the IMPACT Pay-Talk system. Plan definitions and Pay-Talk logic files are created as a joint effort by you and your IMPACT representative.
5. Provider Master File Data
Accurate provider information is critical to the operation of any claims processing system and Impact is no exception to this rule. Provider data can be generated manually or via conversions or downloads. The Impact system has sophisticated tools to help scrub the data during and after it has been loaded that should assist you in building a solid foundation of provider data.
Those users that have PCP’s assigned for each member enrollment may find the provider “on-call groups” subsystem a requirement.
If you choose to maintain provider credentials in the Impact System, the appropriate credential data files should be populated.
6. Case Management & Member Services
The Impact Event Files contain data pertaining to Case Management records including Pre-certifications, Referrals, Large Case, Utilization Review and Utilization Management as well as data pertaining to Member Service Call Tracking and Auto Alert of Medical Conditions. While data conversion of this type of information can be accomplished, it sometimes is data entered on an as-needed basis once the Impact System is in operation.
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7. Claims Billing and Receivables
If your system includes the billing and collecting for services, i.e., the printing and tracking of HCFA’s UB92’s or other bills, the Impact Admin Billing System may come into play. Discuss with your Impact representative which files are candidates for conversion.
8. Admin Billing
If you are a TPA type of organization that will be doing premium billing and other “admin” type of functions, the Impact Admin system comes into play. Discuss with your Impact representative which files are candidates for conversion.
9. Miscellaneous Control Files
Your Impact representative may need to adjust the master file that points to Crystal Reports and other applications with which Impact interfaces.
10. Capitation Rates
If you are an HMO type of organization and will be calculating payments to providers based upon the number of members that have selected each of them as a PCP, you may need to populate the rate table that drives these capitation payments.
11. Claims Data Entry
The Impact claim system allows you to modify the data entry screens for UB92, HCFA and Dental claims. This is done in consort with your Impact representative.
12. Claim Pricing and Adjudication Control Files
Automatic claims re-pricing and adjudication requires various control files to identify and control the pricing and benefit formulas required by your business. For example, if you are processing dental claims, you will most likely want to set up your dental benefit rules in the Impact Dental Logic System.
All users will apply logic to their pricing formulas, whether to simply point to a professional provider rate table or to handle complex facility pricing. The Impact Med-talk system handles these chores. Your Impact representative will train you on Med-talk and assist you in its use.
Med-talk may refer to categories of illnesses and services. For example, Med-talk may need to identify a “young adult mental health problem” referring to specific diagnosis codes within a specific age range. The Impact System lets you establish a series of codes that define these categories. These codes may then be referenced within Med-talk (and elsewhere) eliminating the need for reiterating the parameters that identify each category. These codes are defined in the Medical Category and Service Category files. Although MCSI provides a set of codes and their definitions with the Impact Software, you should tune the use of these categories to suit your operation.
If your pricing formulas require DRG rates (i.e., weight factor, average charge, outlier factor, etc) you need to establish these values in the appropriate Impact DRG table.
If your pricing formulas require rate tables for professional fee pricing such as flat amount rates, RVS rates, RBRVS rates, MDR rates, U&C rates, etc., these tables need to be established in the IMPACT DRG table. Rate tables are usually converted from some electronic source.
Although no master files need to be created for EDI activity, significant testing must be done using the actual data you will be receiving electronically. Be prepared to supply samples of such data from your EDI source.
If you are using the Ingenix Claim Edit System, you should review the control file that invokes the specific edits applicable to your operation.
Claim processing generates messages that print on pricing sheets, face sheets, HCFA’s, UB92’s and elsewhere. In reality, the pricing and adjudication processes generates codes that point to the actual verbiage that will be shown on these documents. The text for these various messages is housed in the “claims message text” file and should be maintained and integrated with the HIPAA code standards.
13. Letter Definitions
Letters are an important part of any claim processing system. Letter templates must be set up for your specific needs, as well as, letter definition records that indicate when and how the letter will be produced.
14. Menu System
The Impact menu system can be modified to suit your requirements. It should be reviewed for security setting and clarity of definintions.
15. Valid Codes Table
Although last on this list, the Valid Codes table is certainly not the least important of the Impact files. This table is the most widely used throughout the entire system. It is shipped with the Impact software containing approximately 34,000 codes that may or may not be pertinent to your business. Most codes in this file will be created and modified during the preparation of the above databases, but there are certain tables within this file that should be reviewed early in the implementation process to avoid later confusion. Specifically look at tables 101 (System Options), 217 (Adjustment Reason Codes), 209 (Denied Reasons), 521 (Product Codes), 522 (Network Codes), 529 (Plan Codes), 535 (Admin Entity & Carrier Codes), 540 (Plan Benefit Codes), and others as directed by your Impact representative.
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