Guide to Replacing Your Legacy Claims System

Many healthcare payers continue to rely on legacy claims systems due to familiarity, convenience, and fear of change. However, the business you run is not the same as it was when you started it. Your legacy system may have supported your growth in the past, but it’s likely reached a point of diminishing returns. The more your operation embarks on new business goals and processes or faces new customer, government, or market requirements, the greater the demands become on the core administrative platform to support those goals.

What is a Legacy System?

A legacy claims system is outdated software that is still in use. Such legacy systems are still functional but not adaptable enough to meet the ever-expanding needs of changing healthcare coverage requirements and demands of claims processing in today’s web-based world. Legacy software is usually difficult to support or adapt to improve due to its old code, outdated architecture, underlying technology, or sub-optimal design.

Why Replace Your Legacy System?

Why are legacy claims systems still so widely used? The answers are straightforward but difficult to admit: sunk cost, inflexibility, fear of change, and even cost-of-change. Legacy system platforms can also be notoriously difficult to replace – especially because they handle some of the vital, everyday business processes within your organization.

Old technology can't solve new challenges. If your claims system fails to address the environments of regulation, market and customer pressure, and increased integration needs, you may find yourself in a standstill position that leads to manual workarounds, unnecessary complexity, missing data, and legacy entanglements.

A Vision for the Future

The Beacon SpyGlass suite is an easy-to-use, cloud-native solution that delivers the flexibility, integration, functionality, and reliability that legacy systems lack.

Legacy System Challenges	SpyGlass Solutions
Lost Business Opportunities As your business continues to grow and evolve, it's important to explore new solutions that can improve administrative efficiency and profitability organization-wide. Too many vendors still require ancient, brittle technologies like remote desktop, to work.	IT Agility With a scalable, cloud-based platform like SpyGlass, you gain real-time collaboration across your departments, which helps to run a smoother, tighter ship. In turn, you’ll experience a greater benefit from the remarkable ease-of-use, while decreasing the overall cost of ownership.
Outdated Technology is Holding You Back As new products and innovations come to market, your customers may ask for more. You may have even noticed that your competitors are steadily creeping ahead. Investing in a modern solution that is as agile and dynamic as your business model will help maintain your competitive edge. Training your staff or setting up a new trading partner file should not be monumental tasks.	Adaptation to the Future SpyGlass delivers the functionality to boost the efficiency of the work you do each day for your customers, while at the same time providing the capabilities to support new product offerings and variations in response to new groups or market opportunities. Your team can quickly become productive on SpyGlass, access it securely from anywhere on any device, and reliably connect with new trading partners.
Operational Inefficiency & Unpredictability If your business model isn’t operating at efficiently as it should, it could be a sign that your legacy system is holding you back. The truth is, in most cases, healthcare payers bound to legacy systems lack the agility to adapt to an evolving market. Utilizing outdated processes and workarounds to overcome system inflexibility harms employee productivity.	End-to-End Automation SpyGlass’s easy-to-use, secure framework allows your employees to fully optimize their time. Equipped with added tools for end-to-end core automation, our application will streamline the flow of your business, helping you avoid manual workarounds. All the required inputs arrive on schedule, right where they need to be to support the decisions SpyGlass’s adjudication engine.
Hidden Costs of Legacy Software The real cost of running a legacy claims system remains high compared to modern, cloud-based solutions. As such applications’ codebases are quite large, even the smallest update or modification can create system-wide conflicts. Just like the software itself, the underlying infrastructure of a legacy system becomes more expensive to maintain as it ages. Additionally, the amount of custom code required for legacy systems to integrate with new third-party partners is significant.	Predictable Costs & Transparent Partnerships With SpyGlass’s cloud-based platform, you’ll be able to stop pouring money into costly mainframes and spend much less on software, hardware, and licensing. Our application is integration-ready by default. Beacon’s comprehensive set of web services and APIs provide real-time access to a vast range of SpyGlass tools, allowing you to connect and integrate virtually every end-to-end data flow between your ecosystem of members, partners, or external applications as well as your internal business systems.
Security & Compliance Risks Security remains a top priority for organizations today as web-based applications extend access to all stakeholders via a common platform. In light of increasing security breaches and compromises, legacy systems are less resistant to cyberattacks, phishing attempts, and malware. As legacy vendors sunset important components, unsupported technology will not see the updates and patches necessary to keep the system compliant with the latest security requirements.	First-Rate Web Application Security SpyGlass and HIPAA Director web application security has been comprehensively tested and certified by industry-recognized vulnerability management solution providers, BreachLock and Plynt. Beacon’s rules- and roles-based framework allows your security administrator to control the full range of user access to the application and transaction features. For stringent authentication requirements, SpyGlass supports 2FA and biometric security capabilities.
Inability to Access Your Data The overall difficulty of exporting critical pieces of data from legacy systems often makes a switchover difficult. As conversions represent the transition of the key data at the heart of your operations from one system to another, the ability to access your data is vital to the success of modernizing your claims administration system.	Conversion Options & Incremental Progress Having converted from multiple systems, Beacon can often help you access your own data. In addition, Beacon’s Data Transformation Tool allows you set up mappings to move data between systems, while our Data Validation Tool performs over 250 validity checks, keeping track of the errors and improvements. We place everything at your fingertips, allowing you to implement confidently with extensive visibility along the way. Alternatively, with a conversion-free approach, you can start fresh with SpyGlass by just transferring essential accumulators and letting your legacy system run out existing business.

A Strategy for Success

• Review Modern Claims Systems
  While there are many different claims system vendors in the marketplace, it’s important to find not just any vendor, but the right technology and the right partner. At Beacon, we're in it for the long haul. Our thoroughly cloud-based suite of applications works well with other systems. We’re passionate about listening to your needs, defining strategies to achieve your objectives, and delivering accountable, comprehensive solutions that fit your culture, budget, and timeline.

• Implementation
  Beacon creates a tailored implementation procedure to effectively put our suite applications into operation in organizations of any size and type. We design a collaborative process to reflect our customers’ needs, specific conversion goals, timing consideration, and implementation philosophy to ensure successful execution. We set up the initial plans and interfaces that you’ll need to get started and provide complete access to documentation to ensure full knowledge transfer.

• Training
  Receiving proper training is an integral part of the success of an implementation. Beacon creates a complete, customized training program for you and each of your specialized teams. We’ll provide all of the necessary tools for you to be in command and optimally efficient with our suite of applications.

• Go-live
  From plan conception through testing, our implementation team consistently delivers a controlled go-live experience, providing you with a quicker return on their investment. We’re with you throughout, and are actively hands-on during the key final testing and go-live events.

Why Beacon is the Right Choice

As technology continues to evolve at a head-spinning pace, having a forward-looking claims administration platform behind your back can be an asset that helps grow your business. With SpyGlass and HIPAA Director, Beacon has been successfully helping healthcare payers modernize their health claims management technology for over 20 years. Now, with Compass Code Edits, we bring lightning-fast, CMS-supported clinical code editing to secure the integrity of your claims payment results. Our team, with deep background experience within the healthcare software development and insurance claims processing industries, brings an advanced level of knowledge and expertise to the challenges faced by healthcare payers, allowing our customers to leverage the power of SpyGlass in the most cost-effective way.

Download our white paper, 10 Signs It's Time to Replace Your Claims System, to learn more about what it means to modernize, how to support legacy claims system replacement, and how a modern solution like SpyGlass can position your company to improve organizational efficiency and profitability.

Break From the Co-Dependency With Your Claims Vendor

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