Providing IV and V services for claims processing system implementation

Organization challenge

A large Federal agency needed to modernize its health claims process to provide more timely and accurate payments created by gaps and inefficiencies in its legacy systems. To meet the long-term goals for this effort, the agency initiated a project to implement a new claims processing system, requiring the integration of custom-developed software, COTS applications and multiple interfaces with legacy systems.

In addition to being a large systems implementation project, this effort also included process re-engineering, claims processing centralization and organizational change activities. Due to the criticality and visibility of the project, the agency added Independent Verification and Validation (IV&V) services to mitigate risks of project failure, overruns and delays, and provide additional insight to the project’s stakeholders.

Baker Tilly solution

Baker Tilly established an IV&V program to provide project oversight throughout the software development lifecycle (SDLC) to address planning, project management, analysis, design, development, testing, implementation, training, quality assurance, and operations oversight. Our objective was to facilitate early detection and correction of errors, increase visibility into risks and provide assurance that the implementation effort was appropriately managed, according to best practices. Our team provided various services throughout the SDLC which included the following:

  • Project charter review
  • Project scope verification
  • Planning oversight review
  • Project plan verification and alignment with the Work Breakdown Structure (WBS)
  • Evaluation of assumptions
  • Risk mitigation plan verification & escalation
  • Office of Management and Budget (OMB) Circular A-123 compliance review
  • Verification of requirements
  • Requirements traceability matrix assessment
  • Design review verification
  • Validation for unit, system integration, and user acceptance testing
  • Organizational change verification and validation
  • Vendor contract review
  • Root cause analyses
  • Change control validation and enforcement
  • Knowledge transition

Results

Baker Tilly conducted detailed project reviews throughout all phases of the SDLC. These reviews contained findings of deficiencies, references to authoritative guidelines, and suggested corrective actions. The IV&V team tracked progress against these findings, providing recommendations to ultimately improve project products, processes, and documentation. We provided status updates on a regular basis to project stakeholders, and in the process became a valued business advisor to the CFO and senior project leadership. Throughout the effort, our team focused on “high-value tasks”, verifying and validating that the future system will ultimately meet the needs of the organization and improve its claims processing ability.

The following figure provides examples of IV&V findings and recommendations, as well as the positive impact our efforts made on the success of the project.