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Veteran Affairs Financial Services Center (VA FSC) processes claims for medical services provided to Veterans outside of the VA Hospital System. To replace an aging legacy system, to replace a non-standardized paper-based process, and to expand services from a regional to national level, VA FSC selected the Pega platform to modernize and standardize claims processing for fee-based services.
VA FSC selected TechCORE MSS as the primary Pega services provider on the prime contract for each aspect of the project: Eligibility and Enrollment (EE), Referral and Authorization System (RAS), and Claims Processing (Claims). The TechCORE MSS team supports the construction, upgrade, implementation, and maintenance of EE and RAS, significantly increasing initial patient interaction efficiency and setting the groundwork for full claims processing implementation with a robust referral and authorization system. System requirements include a web portal solution for major business activities of Veteran healthcare services. TechCORE MSS collaborates with VA FSC during each phase of the software development lifecycle, providing leadership and a broad development skillset.
Using EE and RAS, medical personnel within the VA are better able to provide service to Veterans who need Non-VA medical services with improved efficiency, logical process flows, and specificity per treatment, as required by legislation. These systems are in use at the regional level, with a national level release planned in the near future.