Harvard Pilgrim Health Care Case Study – Partners for more than 25 years

About Harvard Pilgrim Health Care

Harvard Pilgrim Health Care is a full-service health benefits company serving self-insured, small and large group employers, and all market segments throughout Massachusetts, New Hampshire, Maine and beyond. They have been recognized as one of America’s best health plans for 10 years in a row by the National Committee for Quality Assurance.

Situation

Harvard Pilgrim Health Care was continuously growing, and with this growth came scalability issues. In 1994, Harvard Pilgrim Health Care’s leadership team sought out an external solution to implement multiple technology capabilities that would create a more seamless business process.

Solution - Why Harvard Pilgrim Health Care Chose Mosaic

“You always worry about outsourcing,” shares Martha Murphy, Vice President of Sales at Harvard Pilgrim Health Care. “You really need an organization that understands and has been working in the carrier health plan environment for a while.” Outsourcing to Mosaic Insurance Exchange made great business sense to Harvard Pilgrim Health Care because of the years of experience, focused approach, reputation within the industry, ability to deliver and meet expectations, and ability to support Harvard Pilgrim Health Care’s scalability.

Key services Mosaic Insurance Exchange provides Harvard Pilgrim Health Care are:

  • E-billing and Collections – According to Harvard Pilgrim Health Care representatives, one of the most beneficial services Mosaic Insurance Exchange provides is premium billing and collections. Handling broker compensation requires a lot of additional work and would require Harvard Pilgrim Health Care to add many internal resources. Instead, Mosaic Insurance Exchange handles billing and collections directly.
  • Account Management – Mosaic Insurance Exchange offers great communication skills amongst the various accounts and provides the education, strategy and resources the businesses need to stay up to date on the latest changes and technology within the industry.
  • EDI Submission – The EDI files are simple and load directly and efficiently into Harvard Pilgrim Health Care system, allowing for increased accuracy of forms.

    “Being compliant is an ever-changing issue and is becoming more and more complex with the increase in government regulation,” shares Harvard Pilgrim Health Care Vice President of Client Sales, Martha Murphy. “Having the ability to delegate and entrust compliance-related issues to a reliable partner is a wonderful asset.”
  • Call Center Support – Mosaic Insurance Exchange’s call center support matches the level of customer service that Harvard Pilgrim Health Care strives to offer. Customer satisfaction has improved due to Mosaic Insurance Exchange’s concrete call center training, knowledge and industry experts.

Mosaic Insurance Exchange is currently administering a non-group shopping and enrollment site in partnership with Harvard Pilgrim, the site can be found here: http://harvardpilgrim.mosaicix.com/.


Tufts Health Plan Case Study    

Mass Health Connector Case Study