The Client Challenge

A regional Blues plan had to sunset its more than 15-year-old provider data management system. Recent federal policy changes, acquisitions, and enterprise strategy needs further complicated this major transition. The client faced challenges in developing its strategy: What data should it migrate? How should the data reside in a new system? How could it leverage the data to support enterprise goals for the provider and member experience?

  • Understanding and meeting varying requirements that span multiple teams
  • Identifying a single standardized structure for a provider record
  • Accounting for the time and resources required to cleanse data prior to migration
  • Mitigating the impacts associated with excluding or including certain data segments
  • Maintaining an enterprise perspective when making critical decisions

Navigating to Next: The Solution

The health plan wanted to take advantage of its new provider data system capabilities to turn its provider data into a strategic asset, not simply as a repository of information for processing claims and populating its provider directory. Client leadership recognized that provider data can impact enterprise initiatives and the member and provider experience as well. The client partnered with Chartis to develop a data migration strategy.

The planning approach was based on 3 essential elements: (1) an in-depth analysis of legacy data; (2) a technical examination of the data model and the migration process; and (3) a holistic investigation into how the data would impact other areas of the enterprise. Chartis facilitated workshops with stakeholders across the organization to align on key decisions that incorporated broader enterprise perspectives. The team discovered that most provider group records did not require migration, and, of the data to migrate, many records required cleanup. Chartis helped define and prioritize business cleanup rules, size the level of effort, and establish a resolution strategy. Chartis also helped define a long-term data enrichment and accuracy improvement plan to support ongoing and future enterprise needs.

Navigating to Next: Key Components



Understand existing data in the legacy system and its purpose from a business and IT perspective



Facilitate workshops on critical decisions across multiple stakeholders



Identify which data segments to include and exclude and which data to cleanse



Create business rules for data cleanup and set priorities based on downstream impact



Establish recommendations for both data enrichment and data quality initiatives

Client Impact

With Chartis’ support, the payer was able to plan and prioritize the data migration activities within 3 months. The team decided to exclude over 69% of its provider group records that were out of network and had no claims activity in the past 3 years. They also developed 27 data cleanup rules, accounting for additional data quality and enrichment needs that should occur after go-live. With a defined migration strategy, the health plan could shift focus to execution details, such as data mapping, with sufficient time to test and implement the migration. This approach gave the health plan a clean foundation at go-live, instead of migrating data with existing quality challenges.

Within 3 months, the client defined a data migration strategy to establish a strong foundation of data to set the stage for future opportunities:

375 K

records to exclude from migration

30 K

records to clean before or after data migration


data enrichment opportunities to support the plan’s enterprise needs and meet industry requirements

How We Are Making Healthcare Better

A strong provider data platform is a critical foundational component for health plans looking to enhance both their provider and member experiences.

—Bethany Richmond, Director, Chartis

Next Intelligence

Thoughtful and strategic planning for provider data migration requires:
  • Focus on opportunity:
    Aim to capitalize on the new system, only migrating necessary data that is accurate, flexible, and standardized.
  • Stakeholder engagement:
    Hold workshops representing all impacted teams to obtain diverse perspectives on current and futurestate provider data needs.
  • An enterprise lens:
    Understand how provider data supports the business beyond claims and provider directory, turning it into an asset for analytics, network development, and alternative payment models.

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