A Faster Path to Implement Payment Integrity Technology

Health plans no longer have the luxury of highly complex enterprise technology implementations that take years to realize value. An accelerated path to go-live is built on standards. Here’s our streamlined approach to Pareo®, what it requires of your team, and why faster doesn’t mean less valuable.

Enterprise technology implementations at health plans can stretch from several months to a year or more — potentially longer when extensive customization, integrations or system migrations are involved. Meanwhile, PI leaders are under increasing pressure for solutions to deliver measurable value quickly. The prospect of a lengthy, complicated implementation is a barrier that can be hard to overcome.

Recognizing the changing demands of the business environment, ClarisHealth has developed an implementation methodology for Pareo® software delivery that enables plans to go live in as little as four months. Thanks to standards we’ve developed based on our experience completing implementations for nearly 30 PI programs, plans can start realizing value sooner than ever before. Here’s how we make that possible.

“With the Pareo® tech-first methodology, we’re cutting implementation times by more than 50% and accelerating value realization. Vendor managers now have the tools they need — right when they need them — to drive payment accuracy with unmatched speed and efficiency.”

— Sara Thomas, VP of Payer Solutions, ClarisHealth

Standards, Not Shortcuts

To streamline the implementation of Pareo, we have packaged our processes and integrations into an out-of-the-box offering. These standards have been refined over dozens of implementations — including complex projects where we are replacing large scale audit inventory and tracking systems:

• Standard audit workflows, code lists and reports
• Reusable integrations based on standard data layouts already tested and in place for major services vendors — 25+ and counting
• Configurability built into the standard offering
• PI teams begin configuring and working in Pareo quickly after project kick off

These standards significantly accelerate the time to value. As a result, your team could be actively working in the Pareo platform and taking advantage of its automations and visibility in the amount of time it would take to stand up a new services vendor.

“Out of the box, Pareo can automate the checks payers are manually performing on vendor-submitted audit inventory, reduce false positives, and increase the speed of the review.”

— Tom Noack, SVP of Product Strategy, ClarisHealth

4 Client Requirements for Success

We have four identified essential steps on the client side that support a speedier and smoother implementation process.

1. Team members responsible for the transformation should be involved in the decision to incorporate Pareo as early as possible. This communication path ensures they are enthusiastic about the solution and are eager to get started.
2. Designate a project manager, and a group of SMEs, who can prioritize the project — especially in the early stages of implementation.
3. Designate a team member to become your system admin, or “Super User”. This individual typically is someone that is tech savvy, operationally minded, and already managing systems and processes on your behalf today.
4. Teams who are designated to the project should collect relevant processes and any documentation that helps drive the project. They’ll be codifying aspects of their operational process into Pareo. For example, creating a standard list of audit projects that vendors will submit under.

“Getting the buy-in and getting everybody on board with the fact that they’re going to have to set aside some of their day-to-day and make time for this up-front is really the key to success.”

— Jill Foster, Implementation Manager, ClarisHealth

But clients don’t have to shoulder this burden alone. ClarisHealth is on hand to support implementation planning and success, offering information and counsel to help teams get ready for the project.

An Example Pareo Implementation Plan

Though each project varies based on the specific needs of the client, our proven tech-first implementation methodology is designed to deliver value within four months, prioritizing the highest-impact areas.

Weeks 1-2: Discovery and Planning

Implementations begin with discovery and planning. The team has conducted discovery during the sales process that’s handed off to our implementation team. As we kick off, we’ll revisit what we’ve learned, ensure we’re all on the same page, and prepare teams for the configuration phase.

This phase moves fast because we’re confirming how your operation maps to a standard that’s already proven across dozens of health plans, and flagging early anywhere it doesn’t.

Weeks 3-8: System Configuration

With the project plan set, the build begins. User roles and permissions get structured, standard workflows get configured to your environment, and validation rules go in to enforce the business logic your team depends on. Vendor submission templates get set up in parallel, so the vendor onboarding work in the next phase has something to plug into on day one.

This is the longest stretch of the project, and the most collaborative. Your subject matter experts will be in the room regularly, validating that configuration decisions hold up against how your team actually works.

Weeks 9-12: Vendor Onboarding

Vendor work runs concurrently with everything else. Integrations get developed, vendors are trained on the standard file layouts, and file exchanges get validated end to end. If you’re working with a vendor ClarisHealth has already implemented before, this phase moves faster still. The data layout is already built, and the vendor typically only needs to adjust field values, not develop something new.

By the end of this phase, we’re running an initial audit load into the system, which sets up the testing phase to start with real data.

Weeks 13-16: Testing, Training, and Go-Live

User acceptance testing confirms the configuration holds up under real use, staff training gets your team ready to operate in Pareo day one, and go-live preparation closes any final gaps before production deployment. Once you’re live, our team stays closely engaged through stabilization.

From there, you transition to your dedicated Client Success team, and implementation gives way to ongoing optimization.

“Pareo® has allowed us to consolidate a number of workflows, making the processes much more efficient and automated. This has resulted in improved inventory management capabilities. We’ve also received positive feedback on the Pareo UI from our internal team.”

— Director of Claims Cost Management, National Medicare Advantage Plan

Your Team Is Part of the Timeline

A faster implementation changes what’s expected of your team, too. To ensure you meet your targeted time to value, the business case you built to get budget approval and the message you give your team need to move at the same speed as the project itself.

Worth revisiting before kickoff: has anything shifted since you built it? New leadership, a changed vendor mix, provider contracts renewing mid-implementation — any of these can change what Pareo needs to be configured to do. The following questions can help you surface those shifts sooner, rather than later as well as guide your conversations with your team.

Is your team’s headcount or structure changing alongside this project?

If you’re planning to bring on more auditors, insource work that’s currently outsourced, or restructure who owns what, your training plan needs to account for that.

Are you adding, dropping, or renegotiating vendors during this window?

Vendor onboarding runs on its own timeline within implementation. A vendor change mid-project doesn’t have to derail anything, but your implementation manager needs to know it’s coming with as much advance notice as possible.

Do you have provider contracts up for renewal that touch what’s being configured?

Contract terms can affect audit scope, error codes, or exclusion rules. If something’s changing on that front during implementation, flag it early.

Are you cutting vendors over all at once, or phasing them in?

Decide this deliberately. A staged cutover reduces perceived risk but extends the window where you’re running two processes at once. Your implementation manager can help you weigh that trade-off against your specific vendor mix.

Are you launching one audit program first, or going live across all of them?

Starting with your highest-impact program gets a win on the board faster and gives your team a real, contained example to learn from before scaling up. But it’s not the only consideration in your overall program goals. This is another place to lean on your implementation manager’s experience.

Does your team know how to flag a hurdle, and to whom?

Despite best planning and alignment efforts, your staff will hit friction somewhere in the project. A workflow that doesn’t quite match how they used to work, a report that isn’t configured the way they expected. Make sure they know that’s expected, and that the fix runs through their implementation manager, who can pull in training, configuration changes, or the product team as needed.

None of this replaces the communication plan your organization already runs on. If your team responds better to top-down direction or bottom-up input, keep doing that. What’s different now is the cadence: at this speed, a two-week information gap takes up a significant share of the whole project. Say what’s changing, why, and what it means for the people doing the work — early, and more than once.

“It’s important to remember and communicate that digital transformation is not a destination in and of itself. Keep focused on the improvements that digital transformation will bring to daily work life as well as the increased likelihood of reaching organizational goals.”

— Gary Eeds, COO, ClarisHealth

Implementation as a Partnership

Overall, we see the most success with clients who are open-minded, collaborative and communicative about their needs and concerns. We’re committed to honesty, clarity and helping clients overcome any roadblocks that come up during implementation.

These clients also recognize that go-live is just the beginning. They’re motivated to make the most of Pareo with continuous optimization, ongoing training and taking advantage of its capabilities over time to support organizational savings, efficiency and growth.

“A successful implementation is just as much about people and process as it is about the software.”

— Brandi Lynch, Senior Implementation Project Manager, ClarisHealth

Proven Methods and Expert Guidance

Over years of setting up Pareo with over two dozen health plans — of all sizes, structures, and lines of business — we’ve operationalized the most critical elements to create an accelerated timeline. While there are requirements for technical set-up, client preparation, commitment and engagement are also essential factors.

We also bring to bear our perspective on the industry with a particular focus on PI digital transformation. That expertise means bringing proven methods to the process while listening closely to each client’s needs, communicating openly about challenges, and providing clear guidance when decisions need to be made.

Our goal isn’t simply to get clients to the finish line. It’s to give them the foundation, knowledge and confidence to make Pareo an increasingly valuable part of their payment integrity strategy over time.

“If a health plan trusts the process and trusts our team, and they’re engaged and willing to take on the change management that comes with this transformation, everything else tends to fall into place.”

— Brandi Lynch

Talk to ClarisHealth about how Pareo® payment integrity operations platform  is helping health plans scale their programs and demonstrate value to the enterprise faster.