Automating Healthcare Data Management: A Case Study of Care1st Health Plan Arizona

Care1st Health Plan Arizona, a Phoenix-based healthcare provider, faced a significant challenge when they expanded their services from Maricopa County to Pima County. This expansion increased their enrollment from approximately 50,000 to over 70,000 individuals almost overnight. The organization had to quickly update or add line-of-business records, provider panels, and other records to ensure continuity of coverage and reimburse providers. Additionally, as a newly-named Third Party Administrator (TPA) for Arizona’s insurance cooperative offered through the new National Health Insurance Marketplace, the organization was preparing to handle potentially thousands of new enrollees and provider records over the coming months. The organization traditionally used up to 15 different macros per day to perform large data entry and maintenance tasks, but these were unreliable and required constant monitoring. The small provider data management team was often pulled away from their daily work to manually enter smaller jobs of fewer than 200 records.

Care1st Health Plan Arizona is a Phoenix-based healthcare provider that offers coverage to beneficiaries of the Arizona Health Care Cost Containment System (AHCCCS). The organization recently expanded its services from Maricopa County to Pima County, increasing its enrollment from approximately 50,000 to over 70,000 individuals. In addition to this, Care1st Health Plan Arizona was also named as a Third Party Administrator (TPA) for Arizona’s insurance cooperative offered through the new National Health Insurance Marketplace, which meant they were preparing to handle potentially thousands of new enrollees and provider records over the coming months.