The Department of Veterans Affairs (VA) Community Care Claims Processing System Support (CPSS) – a program that Favor TechConsulting, LLC (FTC) led and managed from June 2017 to December 2021 – was named a FedHealthIT Innovation Award winner. Recognizing the Federal Health technology and consulting community, the 8th Annual FedHealthIT Innovation Awards honors programs nominated and selected by their peers for driving innovation and results across the Department of Veterans Affairs, the Military Health System, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services.
To support the next generation of Veteran care, the VA engaged FTC in 2017 to build and implement a custom solution to automate the validation of claims and processing of reimbursements to Third Party Administrators (TPA) providing care for Veterans in a community-based care model – with TPAs delivering care to Veterans through their own Provider Network, remitting payment to providers on behalf of VA, and invoicing VA for reimbursement through the Community Care Claims Processing System. Working shoulder to shoulder with VA leadership, the FTC team delivered a transformative AWS-hosted Software as a Service (SaaS) solution that has increased and accelerated Veteran access to care, reduced provider attrition, and transformed the way VA processes and pays healthcare claims. With this automated solution, not only has the claims processing system been able to remit payments to TPAs in only six (6) days, but also cut the VA cost per claim by more than 80%, saving the VA over $267M since the inception of the program. Processing on average 3.2M claims per month, the claims processing system has paid more than 53M claims to date for a total of $28B, with a denial rate of just 0.7%! Further system upgrades have integrated the VA “Offset” process into the reimbursement workflow, allowing VA to recoup over $24M immediately, without requiring a lengthy Bill of Collections. This number continues to grow, allowing VA to use these recoupments to fund Veteran health and support other programs to improve quality of care. This has all established Community Care Claims Processing as an exemplary success story.
“The Community Care Claims Processing System means a great deal to FTC and me personally,” commented FTC Chief Delivery Officer Tom Kenny. “This project is a shining example of what happens when an innovative organization such as ours and a visionary Department such as the VA are successful in a shared mission to make a positive impact in the lives of the Veterans and their families through technology and empathy.”
Award recipients will be celebrated at the 8th Annual Awards and networking event, held at the National Press Club in Washington DC on June 7th.
Favor TechConsulting, LLC (FTC) is a leading IT solutions and services provider that has been driving digital transformation for Federal Government agencies since 2007. Specializing in Agile Transformation, IT Infrastructure & Modernization, Cyber & Threat Detection, Data Science & Analytics, and Intelligence Engineering & Operations, FTC delivers mission success through Next-Gen IT solutions and services that transform – and transcend – the status quo.
ABOUT THE FEDHEALTHIT INNOVATION AWARD PROGRAM
The 8th Annual FedHealthIT Innovation Awards event recognizes and honors the Federal Health technology and consulting community by celebrating the programs nominated and selected by their peers for driving innovation and results across the Department of Veterans Affairs, the Military Health System, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services.
For the complete list of award winners, click here: 2022 FedHealthIT Innovation Award Winners – FedHealthIT