At a glance
Industry
Healthcare
Location
United States
Products and services
Facets core administration system
Challenge
Achieve stringent federal security authorization for cloud-hosted managed claims processing service
Success Highlights
- Compliance with NIST SP 800-53 Revision 5
- Earned FedRAMP authorization
- Introduced new processing capabilities for specialized claims
- Exceeded federal security standards
The challenge
Our approach
Signature Performance saw obtaining the FedRAMP authorization, which was required for a new government contract, as an opportunity to improve overall security. Enhancing security would strengthen Signature’s position in the public health sector, enhance its reputation in the industry and demonstrate its continued commitment to securing sensitive data.
The company’s journey to FedRAMP authorization began with a thorough study of NIST SP 800-53 Rev. 5 and its requirements, followed by a comprehensive gap analysis to identify areas needing improvement. This analysis guided Signature in developing a detailed implementation plan, ensuring that every control was addressed systematically.
Signature and Cognizant teams worked together to identify and modify aspects of the Facets platform necessary to comply with NIST SP 800-53 Rev. 5. Our teams also collaborated on Signature’s journey to expanding medical claims processing to pharmacy and foreign claims. Together, we conducted an initial needs assessment to identify the appropriate extensions and configurations in Facets that would best support the required functionality. The teams leveraged native Facets functionality alongside custom code to develop a process that met their government contract requirements and allowed for future scalability in terms of client, process or product diversification.
ClaimsXM's unique provider creation process involves multiple layers of data validation and matching to ensure accurate claims processing. The inclusion of foreign claims enabled Signature to meet their government sponsor’s specific needs for external data matching while streamlining the handling of exceptions or deviations in provider data presentation. A new specialty claim type had to be introduced to meet stringent requirements for provider creation based on custom matching to external data sources. This advancement allowed Signature to transition from manual input by development resources for edge cases to automatic or semi-automatic adjudication of complex claims.
Signature also implemented new data cleansing rules for provider data, addressing a significant cause of claim lifecycle fallout. By laying the groundwork for error codification and handling for providers, Signature has set the stage for expanding this data validation to other claim types.
Business outcomes
Partnering with their US federal government sponsor, Signature developed a comprehensive System Security Plan (SSP) that detailed security measures, architectural safeguards and risk mitigation strategies. Engaging a third-party assessment organization (3PAO) for independent validation was a pivotal step toward the FedRAMP authorization.
The implementation of these solutions led to the achievement of FedRAMP authorization. This authorization proved that the VFMP claims processing system exceeded stringent federal security standards, including the NIST SP 800-53 Rev. 5 framework, ensuring robust protection of sensitive veterans’ information.
