End-to-End Benefit Validation Tools Ensure Seamless Member Transitions
When a health plan changed PBMs for the first time in 10 years, PSG helped ensure a seamless implementation and transition.
testing claims validated prior to go-live
real-time claims validated after go-live
The Challenge
A regional health plan consisting primarily of government programs came to PSG for a PBM implementation and benefit validation testing. They had not changed PBMs in over 10 years, so their focus was finding a partner that had a depth of expertise they could trust to ensure a smooth go-live with minimal member impact.
The health plan needed to validate that their benefits would process as intended with the new PBM, but lacked the experience and staffing to perform a comprehensive benefit validation ahead of their go-live. Additionally, they needed to monitor production claims after the go-live to ensure appropriate processing for members post-transition.
PSG’s Supporting Services
Implementation: PSG offers an extensive programmatic approach to augment PBM implementation efforts and help ensure a seamless, successful PBM implementation.
Benefit Validation Testing (BVT): A pre-implementation tool that ensures a 360-degree review against your source of truth and minimizes member impact related to plan design setup errors.
Active Check: A post-implementation tool that leverages six weeks of live data to ensure claims are processed and adjudicated correctly.
Learn More
PSG’s comprehensive benefit testing tools ensured a smooth transition for members. Download the case study to learn more.