Large-scale healthcare IT transformations often happen out of sight but shape the industry for decades. One of the most ambitious of the past decade was the migration of a major U.S. health system from its aging claims platform into FACETS, a core administration system built to handle the growing complexity of modern payer operations. With a price tag north of $74 million over three years, the program carried considerable technical and regulatory risk: failure could disrupt claims, delay provider payments, and threaten HIPAA and CMS compliance. Success would deliver a durable backbone for patient care, provider networks, and value-based reimbursement.

At the center of this high-stakes effort was Praveen Rawat, a leading authority in the U.S. Healthcare Payers/Providers domain. Rawat was responsible for architecting the business configurations, data migrations, and integrations that would bring the system live — and ensure it could adapt to evolving industry demands.

Rawat’s core focus was FACETS business and systems configuration, the intricate but essential work of aligning claims workflows, enrollment, billing, provider management, and utilisation management with operational realities. Each configuration decision influenced how policies translated into payments and how provider and member data flowed through the system.

Data migration was equally challenging. The legacy platform held years of provider records, fee agreements, and claims logic. Rawat spearheaded the mapping, cleansing, and integration of that data into FACETS, ensuring accuracy and continuity. As he explains, “Migration isn’t just about moving data. It’s about preserving business meaning so that yesterday’s claims still make sense in tomorrow’s system.”

Rawat also helped design payer-to-payer integration with a national managed-care partner, enabling seamless exchange of claims, eligibility files, and authorisation data. The result was stronger data consistency, fewer redundant processes, and better support for value-based contracts and population health initiatives.

Though the project’s initial goal was regulatory compliance, Rawat’s architecture proved forward-looking. The clean data structures, modular rules, and interoperable pathways he helped build form the same foundation powering today’s push toward FHIR-based APIs, real-time prior authorisation, and payer-to-payer interoperability. Reflecting on the evolution, he notes, “What we did then was about regulatory survival. But the foundation we built — clean data, modular rules, interoperable pathways — is exactly what’s powering today’s interoperability push.”

Rawat is equally attuned to emerging technologies. AI now assists with claims adjudication, provider data cleansing, and fraud detection — tasks that once required extensive manual effort. “AI is the logical next step,” he says. “It doesn’t replace expertise; it amplifies it.” He also highlights RPA as essential for scaling repetitive processes: “If you can automate it, you should.”

On security, he sees blockchain as an important complement to APIs: “Interoperability has to come with trust. Blockchain is one way to hardwire that into the system.”

The enduring success of the FACETS migration speaks to the strength of the underlying architecture. For Rawat, its longevity is the true achievement: “The best systems aren’t the ones you notice every day. They’re the ones that let you focus on patients and providers instead of chasing errors or exceptions.”