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IT Consulting for Health Plans

Blue Eagle Consulting understands that running a health plan today means facing constant challenges—including continuous pressure from rising medical costs effecting insurance premiums, fierce competition, and never-ending reform efforts. Our consultants, with a minimum of 5 to 7 years’ experience, can help health plans deliver top-quality, integrated care while reigning in costs.

Health plan experts are prepared to help you seamlessly and cost-effectively administer IH (integrated health) benefits. Partnering with Blue Eagle can help guarantee that your health plan generates strong bonds with patients and a significant return on investment, with such services as:

  • Supplying both the core clinical and financial solutions your organization needs today as well as the advanced applications you’ll want in the future
  • Minimizing IT infrastructure requirements and overhead
  • Providing onsite implementation or upgrade assistance
  • Delivering special subject matter expertise to implement and properly configure
  • Easing the burden of a large-scale HIT (health information technology) project
  • Adapting to the shift to accountable and value-based care
  • Implementing best practices
  • Detecting fraud and abuse
  • Analyzing claims

Blue Eagle’s health plan SMEs (subject matter experts) can help with System Selection and Implementation through Configuration, Optimization, Systems Support, Staffing, Plan Build, Analytics, and Go-live.

Our consultants have hands-on experience with all the leading technology systems and software, including  Trizetto (Facets and QNXT) as well as Amisys, and many more.

Blue Eagle’s strategic advisory services for health plans are focused on helping you select the most appropriate IT system for your organization, including assisting you with such import upfront needs as:

  • IT Strategy and Planning
  • System Selection
  • Assessments
  • Contract Negotiation
  • Project Cost Estimating

We take the time to understand and leverage your health plan’s organizational culture, and hierarchy, as well as member patients, medical staff, and employee dynamics. We craft solutions to make sure your system meets your health plan’s objectives and key initiatives while generating staff enthusiasm and commitment through:

  • Listening to what you want to do
  • Interpersonal communications
  • Working with your team
  • Turning your vision into a realistic, how-to-do-it strategy
  • Development of an achievable tactical plan, with an approach, methodology, and resources to stay on schedule and on budget

Our consultants have hands-on experience with all the leading technology systems and software, including TriZetto®  Facets™ , QNXT, ika, HealthEdge and Amisys.

TRIZETTO®, Facets, CareAdvance®, NetworX PRICER® and QNXT are trademarks owned by The TriZetto Group, Inc. Blue Eagle Consulting is not affiliated with The TriZetto Group, Inc. and The TriZetto Group, Inc. neither sponsors nor endorses our materials, goods or services.  

Blue Eagle’s Implementation Services cover the full gamut of technology and organizational readiness, from Pre-Implementation Workflow/ Business Process and Configuration, Claims and Plan Build, to planning to Membership, Eligibility, Provider Contracts, Implementation, and Training. We support our health plan clients through every stage of implementation planning and readiness.

We’re at the ready to assist your health plan with important implementation issues, including:

  • Certified Analysts and BAs for Implementation/Build/Design/Go-Live
  • Pre-Implementation Planning
  • Workflow Assessment, Documentation and Design
  • IT Organizational Readiness and Design
  • Activation
  • Leadership Development & Mentoring
  • Project Management
  • Workflow/Business Process
  • Customer/Member Service
  • System Build
  • Testing and Quality Assurance
  • Training
  • Medical Management to evaluate, promote, and coordinate quality and cost-effective services
  • Special Assistance from RNs with experience in UM (utilization management), CM (case management) and DM (condition and lifestyle management)
  • Documentation
  • Policies and Procedures
  • EHR (electronic health record) Implementation
  • CMS Business Rules and Requirements (Medicare/Medicaid/Medicare Part D)

At Blue Eagle, we recognize that IT success goes way beyond system implementation. Through our optimization services, you can maximize the long-term value and effectiveness of your technology solutions. That’s why Blue Eagle will help with:

  • Performance Improvement
  • Revenue Cycle Management
  • System Upgrades
  • Post-live Assessments
  • Reports/Analytics

In addition, our consultants can also offer specific EHR Optimization Services. Whether you are stabilizing, addressing a specific problem area, or are ready to take your system and users to the next level, Blue Eagle can bring you the talent to improve and optimize your hospital’s EHR adoption, including:

  • Nursing
  • Patient Merge
  • Medication Management
  • Immunizations
  • History Builder
  • Flow Sheets
  • Charges
  • Documentation
  • Claims
  • System Enhancements and Support

We have the high-quality resources to help you build, support, extend and optimize your IT and management systems. Blue Eagle consultants have hands-on experience with the leading software vendors, so we can provide additional personnel when you need them for as long as you need them, including:

  • Configuration and Optimization SME’s
  • Claims
  • Plan Build
  • Membership/Eligibility/Provider/Contracts
  • Implementation/Training
  • Testing and Quality Assurance
  • Documentation
  • Policies and Procedures
  • Workflow/Business Process
  • Project Management
  • Customer Service
  • CMS Business Rules and Requirements (Medicare/Medicaid/Medicare Part D)
  • Certified Application Analysts
  • Workflow advisement
  • Instructional Designers and Trainers
  • Interim Clinical Support (Prior-Authorization, Chart Review, HEDIS, etc.)
  • Interim IT Team Managers and Directors
  • EHR Coding Assistance
  • Activation Support
  • Legacy Support
  • Data Analysts
  • HEDIS/Chart Review
  • Utilization Management

Plus, we also offer these specialized resources:

  • Specialized Nurses—Pre-screened RNs and LPNs to assist with your clinical needs. They can augment your time sensitive HEDIS chart reviews, Prior Authorization assistance, Appeals and Audits, clinical chart review, and more our team can assist. Each member is extensively vetted and has experience in GPR, STARS, billing, coding, and utilization updates, pre-authorization, or project management.
  • ICD-10/HCC Consulting Resources—to ensure a smooth ICD-10 conversion at any stage or your ICD-10 project, from planning and strategy; to implementation; to program and project management; to code mapping, interface development and upgrade, payer and vendor testing, updates to billing, coding, and utilization; to specialized implementations (labs, payers, reports); to new billing workflow, to post-go-live support for all major EHR vendors

Healthcare margins and reimbursements are shrinking every year. The steady stream of new rules, new codes, and new quality measures mean that your ability to optimize performance and make key decisions for your organization are under constant threat. A strong, reliable data environment is your key to making decisions, advancing program performance, and achieving a new level of overall organizational awareness. Click here for an overview of our Data Analysts services.  

Blue Eagle analytic services provide the “heavy lifters” for your hospital’s data projects. Our veteran consulting resources and business analysts have both the software/technical and operational/clinical expertise answer this growing need with assistance to help you:

  • Enterprise Data Warehousing—to corral data from EHR and other clinical systems corral EHR data from its various sources and making it accessible and usable in decision-making…including managing data abstraction, conversion and archiving projects in enterprise environments
  • Enterprise BI (business intelligence) Assessments—to evaluate and audit the current state of your data compared to current industry standards and applicable CMS guidelines, recommending solutions, providing reporting resources, and managing projects
  • Reporting Optimization/Backlog Relief—to take specs and generate reports, plus also direct you to the most meaningful information, including training your team to operate more efficiently, or assist in clearing a backlog reports that may have your current technical staff overwhelmed
  • Architecture support (HL7, X-12)
  • 5010
  • EDI/HIPPA (837, 834, 835,820)
  • Interface/Integration services
  • HCC coding and risk-adjustment services
  • Custom report development
  • Date Conversions/Migration
  • Data Mapping and Modeling

What’s new? What’s a hot topic? What regulations should you know about? What’s Blue Eagle been up to? How can our consultants help your organization? Our useful, informative, enlightening resources help you stay in-the-know with:

  • eBooks on such topics as significant subjects as finding the right healthcare consulting partner and getting value out of your vendor management partner
  • Blogs that regularly tell you about upgrades, changes, staffing decisions, regulations, testing, and much more
  • White Papers to guide you through specific topics of interest to hospitals, like coding compliance
  • Case Studies to show exactly how Blue Eagle consultants have helped healthcare organizations around the country meet and exceed their needs

We can best support your health plan with consistent results. Whether you need to install a new EHR (electronic health records) platform, provide maintenance and upgrades to an existing one, or simply make HCC coding easier and more efficient, Blue Eagle Consulting’s skilled professionals and project teams provide the expertise that complements your health plan staff and needs.

Our focus is on the quality and value of a relationship, not the number of them. We work with an individual client’s needs to provide “A-list” consultants to meet specific organizational directives.

To learn more about Blue Eagle Consulting services click here.



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