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April 2, 2006

Blue Cross and Blue Shield implements claims adjudication system

Blue Cross and Blue Shield of North Carolina has implemented a claims adjudication system to process its institutional and professional claims.

By CBR Staff Writer

The system filters claims, suspending those it feels need further action and routing them to process automation software supplied by Image Process Design. Previously, these suspended claims were routed to knowledge workers who evaluated associated claim information to determine whether or not the suspended claim should be paid.

With the new system in place Blue Cross and Blue Shield North Carolina (BCBSNC) says that 85% of the claims are now being adjudicated automatically, without human intervention. The remaining 15% of these suspended claims are routed, without noticeable delay, for human attention. Blue Cross and Blue Shield estimates that the savings per claim processed generate annual savings of approximately $250,000.

Sherman Owens, vice president of quality and compliance for BCBSNC, stated, 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.

He added. 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.

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