Blue Cross and Blue Shield of North Carolina (BCBSNC), the state’s largest health insurer, needed to rapidly assess and adjust their approach to how they handled provider data from myriad sources across all 50 states. The size and scope of BCBSNC’s provider network required a deep audit of their system architecture and a critical look at how their processes and system could be made scalable and effective.
Read more to discover how Mediant Health Resources was able to exceed Blue Cross and Blue Shield of North Carolina’s expectations once more.
Since 1933, Blue Cross and Blue Shield of North Carolina has provided high quality health insurance at a competitive price. Among BCBSNC’s initiatives has been a charge toward better health and more consumer-focused health care in their state. BCBSNC employs more than 4,700 North Carolinians and serves more than 3.89 million customers. The Blue Cross Blue Shield of North Carolina’s PPO network includes 96% of medical doctors and 99% of all general acute-care hospitals in the state.
Previously, BCBSNC turned to Mediant Health Resources for immediate remediation and training after a third party vendor error and system failure led to a very public breakdown and widespread customer billing issues. This arose two years into their multi-stage implementation of Cognizant’s Trizetto® FacetsTM enterprise core administration and billing/claims processing platform. Pleased with Mediant’s performance and service with their previous emergency needs, BCBSNC partnered with Mediant once more for an assessment of provider data.
The Blue Cross and Blue Shield of North Carolina’s network spans the nation BCBSNC’s in-state PPO3 network of healthcare providers includes 96% of medical doctors and 99% of all general acute-care hospitals. When outside the state, members have coverage with doctors and hospitals in all 50 states.
Before BCBSNC could continue converting any additional groups to Facets Core Administration, provider data needed to be reviewed to assess it’s scalability and health as well as its effect on members, providers, and internal teams.
BCBSNC consulted with Mediant Health Resources, a leading healthcare IT support and staffing company who had already demonstrated their exceptional ability to provide expert consultants and meet tight deadlines under pressure. Mediant was able to rapidly provide five consultants, each of whom boasted more than 15 years of experience in both FacetsTM and healthcare architectures.
Mediant’s experts were allotted a 12-week timeframe to assess provider data in order to identify key pain points and problematic data sets before performing root cause analysis and providing solutions based on industry best practices. Five deliverables were established as key to the project’s success at this stage:
• An in depth provider data audit
• A detailed process assessment
• A thorough systems architecture determination
• Quality assessment
• A provider data roadmap, or “manifesto”
Once again, Mediant Health Resources proved their performance and value to Blue Cross and Blue Shield of North Carolina. Mediant rapidly understood the provider architectures and delivered the in-depth provider data audit ahead of the scheduled 12-week deadline. This audit discovered data anomalies, including duplicate records, which negatively impacted claims matching and correct payment processing.
Mediant then conducted a detailed process assessment which brought to light the extensive manual workload required of BCBSNC teams in order to keep two systems in sync. Prior to Mediant’s involvement on this project, BCBSNC relied on six and a half full time equivalent staff members in order to accomplish this task. From there, Mediant reviewed the payer’s system architecture.
Mediant’s assessment of BCBSNC’s architecture highlighted inefficiencies that needed to be resolved. Additionally, this assessment illuminated both the lack of and need for a data quality process to ensure the system’s “health” moving forward. Accomplishing this along with the other assessments led to the creation of the final deliverable.
Mediant’s experts pulled together the information from the four initial assessments to create a “Provider Manifesto.” This document was a roadmap and common set of rules, known issues, and best practices for provider data developed to meet Blue Cross and Blue Shield of North Carolina’s specific needs.
Throughout the engagement Mediant managed the project successfully and with high efficiency. Leadership was able to communicate the urgency of the issues uncovered as well as the necessary outcomes across the organization. Not only was Mediant able to initiate phase two of the project two weeks ahead of schedule, but the quality insights provided to BCBSNC gave the organization a clear and confident path forward. The project was completed on time and on budget.
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