But making QMACs
or QNECs means raising the stakes.
We use QMACS for our core system and for claims adjudication," Erickson explains.
But because everything in the four states Molina Healthcare now serves is on the QMACS system, issues that may come up order contracts, claims or benefits can be handled from the corporate offices in Long Beach via a wide area network that connects the offices in each state.
We had 95 permit being loaded electronically into QMACS by August 2003," Erickson says.
But because QMACS is customizable, the process took half the time for the Washington Health Plan conversion.
First, QMACS is Microsoft-based, and implementing it into our existing, homogenous Microsoft infrastructure would be a smoother transition.
The committee agreed with our reasoning and supported the QMACS purchase.
Since QMACS had never been implemented in a Taft-Hartley plan prior to MPI, there was a learning curve that included the specific differences in Taft-Hartley benefits, accumulators and coordination of benefits processes, compared to a typical health plan.
Throughout this period, the IT and operations staff underwent extensive three- and four-week training and cross-training sessions in client/server architecture, Microsoft SQL, claims processing, as well as QMACS training.
QCSI wanted to showcase its ability to scale up to 10 million users with its multi-tier QMACS client-server software, having installed many systems for health plans up to 200,000 members.
In the highest load one-hour test, with a load of 4,000 concurrent users, QMACS adjudicated 23,863 claims and 41,361 claim lines representing 3,763,092 individual requests for data access or modification.