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VETERANS AFFAIRS - REFERRAL & AUTHORIZATION PROCESS AUTOMATION
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 Management Solutions Services formerly ArchiTECH Solutions 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 supported 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 included a web portal solution for major business activities of Veteran healthcare services. TechCORE MSS collaborated 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. Designed for use at the regional level, these systems proved so successful they were released at the national level per Congressional action.