Blue Cross and Blue Shield of North Carolina eliminates the need to manually work suspended claims routed to IPD�s Automation Engine software. The initial pilot alone generates an annual cost savings of $250,000.
Bloomfield Hills, Michigan (April 4, 2006) Blue Cross and Blue Shield of North Carolina (BCBSNC) uses a popular claims adjudication system to process its Institutional (UB92) and Professional (HCFA) claims. When the adjudication system makes a determination requiring action by a knowledge worker it suspends the claim and moves it into process automation software supplied by Image Process Design, Inc. (IPD).
Previously, these suspended claims were routed to claims adjudicators (knowledge workers) who evaluate associated claim information to determine whether or not the suspended claim should be paid by BCBSNC. With increasing claim volumes, BCBSNC believed that the process could be further improved.
BCBSNC chartered a joint pilot with IPD to determine if greater efficiencies could be gained by automating all or part of the manual effort associated with these suspended claims with IPD�s new Automation Engine module. Sherman Owens, Vice President – Quality and Compliance for BCBSNC identified “Potential Duplicate” claims for the pilot.
IPD engineers, working with Mr. Owens� team, incorporated specialized business rules within the Automation Engine software to process these duplicate claims accurately and efficiently through a highly automated process. The initial result is that eighty five percent of the claims processed by Automation Engine are now being adjudicated automatically, without human intervention. The remaining 15% of these suspended claims are routed, without noticeable delay, for human attention.
The Automation Engine pilot is generating a significant cost savings compared to the previous process. The savings per claim processed just through the initial Automation Engine pilot generate an annual cost savings to BCBSNC of approximately $250,000.
Mr. Owens states that; “Our claims staff at BCBSNC is very excited about the new process. All suspended claims are already managed by IPD�s software. The Automation Engine module retains our complete control over claims work in process, but allows us to seamlessly add greater levels of process automation and specialized rules. The next logical step is for BCBSNC to utilize the Automation Engine module for more suspended claim types. We expect to save well over $1 million per year in our Claims operations with just the next several suspended claim types.”
About Automation Engine
IPD�s Automation Engine Module is one of many new features and functions in Ultera v6.5. Through a unique combination of business rules, automation and integration, the IPD Automation Engine transforms previously manual processes into automated tasks. With millions of manually intensive transactions received by health insurance payors annually, the ability to avoid assigning all of them to internal staff for resolution provides significant savings. Ultera�s Automation Agents work within this framework to perform identified tasks at specific points in the workflow process.
About Image Process Design, Inc.
Image Process Design, Inc. (IPD) was founded in 1991 by Steven Racine after he served as the National Director of Imaging/Workflow Consulting for KPMG Peat Marwick. The concept was to improve on an insurance industry practice of building expensive, high risk, custom systems to address their need for faster, more accurate decision-making. IPD addressed the industry�s emerging needs with process oriented design methodologies and a prepackaged, cost-effective software solution with business-specific functionality. This was a unique business model in an industry dominated by systems integrators and costly “run away” projects. For the first time, the industry�s process and document management needs were addressed with out of the box software solutions that could be configured and rapidly deployed with immediate payback. Today, IPD�s products continue this tradition of low-risk, proven solutions featuring both the highest degree of scalability and an open architecture design.
IPD introduced a client server version of its software, Solution Suite, in 1995 and a thin client version, Ultera, in 2000. These are supported, out of the box software solutions designed to address the wide range of specific business process requirements in the Health, Life, Disabilityand Property and Casualty insurance businesses. Solution Suite and Ultera are enhanced with each installation and supported by a product development team dedicated to addressing your business demands. IPD�s Ultera software has gone through more than 15 years of refinement, many millions of dollars in R&D, and features over 500 discreet areas of functionality specifically targeted toward efficient insurance processing. No custom solution can match this advanced functionality. As a result of this focus, IPD software is now installed in nearly half of the Blue Cross/Blue Shield Plans across the country, as well as numerous other well-known Life and Health insurance companies.
IPD remains an independently owned company headquartered in Bloomfield Hills, Michigan. IPD maintains sales offices throughout North America. http://www.ipdsolution.com/
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to nearly 3.3 million members, including approximately 639,000 served on behalf of other Blue Plans. For 72 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organization, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at www.bcbsnc.com.