Universal HealthcareBy NextBestFit
Phase 1: Enactment & build · Step 1.3

Build the claims, payment & data systems

Months 0–18, then continuous · UHA Chief Information Officer; MACs; U.S. Digital ServiceDiscuss this step
operationallikelihood: mediumimpact: high

Claims system failure at launch

Providers go unpaid; patients are turned away. HealthCare.gov's 2013 launch is the cautionary tale.

Early warning signs
  • Parallel-run error rates
  • Load-test results
  • Independent verifier reports
Mitigation
  • Extend proven Medicare systems
  • Go/no-go gate
  • Interim payments based on prior-year billing

Implementation risks

RiskMitigation
Launch-day failure (HealthCare.gov, October 2013).Independent verification, parallel run, phased enrollment waves, and a legal fallback that pays providers interim amounts based on prior-year billing if claims processing fails.
Ransomware or outage.Geographically redundant processing across MACs, offline interim-payment protocol, and a mandatory security baseline for all connected providers.