Annkissam Case Study Our billing software involves sending insurance claims in a standardized…

Annkissam Case Study

Our billing software involves sending insurance claims in a standardized format to payers (insurance companies) and receiving remittances from payers in a corresponding format. Service data is imported into the system, claims are automatically created, and clients are then able to upload the remittance files to track which payments have been received and follow up accordingly. While the claim formats on paper and electronic files are standardized, required fields may vary by program and state, and some programs require additional data reported on spreadsheets.

For this case study, you will take on the role of product manager looking into expanding the product into a new market, for a state Medicaid program that the software does not currently support. Please provide a brief write-up of the following:

1. Who might the stakeholders be in this initiative?

2. What are some initial considerations we should look into or ask a stakeholder to confirm?

In other words, what pieces of information or documents would you ideally like to have before starting development to accommodate this new Medicaid program? In your response, please identify what might be reasonable to have stakeholders provide, and what you would be able to research on your own. Where would you start looking for this information?

3. Once we have the necessary information to begin development, what are your next steps? Please include:

  1. Strategies you will employ for communicating with stakeholders throughout the development process
  2. How you will keep this process organized
  3. Some potential roadblocks that could arise and how will you account for them
  4. Challenges we might face in implementing this new program.

3. After initial testing with the standard electronic claim format was accepted, the state indicates that they now need EVV data reported alongside the 837 billing files in a spreadsheet format.

  1. What information do you need to move forward, and who would you need it from?
  2. What are your initial considerations for planning this aspect of the project?
  3. How would you approach this new requirement with an existing client, and with developers on your team?

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