Covisint - BlueCross BlueShield

Recognizing opportunities to improve workflows and reduce cycle time, BlueCross and BlueShield of North Carolina (BCBSNC) and BlueCross and BlueShield of South Carolina (BCBSSC) collaborated to find an efficient solution to handle claims attachments and their inter-plan communications. Both plans were already using Covisint’s ProviderLink technology for utilization review transactions and determined that the same technology could transform their paper-based workflow for claim attachments.

Situation

BlueCard is a program of the BlueCross BlueShield Association that provides a seamless health insurance product in the national marketplace. At BlueCross and BlueShield of North Carolina (BCBSNC) when an out-of-state member sees a North Carolina provider, claim attachments such as medical records are often collected by BCBSNC as the host plan and then sent to the home plan in the state the member lives in for processing. This workflow has multiple touch points and has been challenged by a dependency on paper and traditional mail service.

Recognizing opportunities to improve workflows and reduce cycle time, BlueCross and BlueShield of North Carolina (BCBSNC) and BlueCross and BlueShield of South Carolina (BCBSSC) collaborated to find an efficient solution to handle claims attachments and their inter-plan communications. Both plans were already using Covisint’s ProviderLink technology for utilization review transactions and determined that the same technology could transform their paper-based workflow for claim attachments.

Solution

Form Designer & Publisher. Using Covisint’s web-based form designer, the request form letter is now available in a structured electronic format for online providers. The request for attachments form contains built-in validation rules that flag users when data is missing or erroneous, before the form is sent to the provider.

Bi-directional Fax. BCBSNC and BCBSSC both use Covisint’s bi-direction fax service to request attachments from providers. With Covisint’s fax-back capabilities, providers fax the request using a dynamically generated bar-coded, fax-back cover page. When faxed, the medical record is automatically imaged and attached to the patient's unique record and “request” workflow item. Users receive online attachment requests and they can fax or virtually print image the attachment directly to the payer's online request. This provides for a single workflow for both online and fax-only providers.

Better Health and Lower Cost

Improved Efficiency with Reduction in Cycle Times, Re-requests and Follow-up Calls. Claim resolution cycle time was reduced by an average of 12 days. Providers got their requests for attachments much faster and were able to respond without using the postal mail. The volume of re-requests for claims information dropped by approximately 33%. Even when a home plan re-requested records, the host plan could identify the duplicate and not submit it to the provider.

Accountability/Staff Interchangeability. The payer and provider could quickly analyze workflow, and identify and resolve communication bottlenecks. If an employee was absent, staff could interchange with ease having the entire request and response process history available online.

Immediate Cost-Free Provider Adoption. No training or intervention was required to get even the smallest providers to adopt the new online or fax-back process. BCBSNC and BCBSSC simply sent the fax-back, bar-coded cover page with instructions on it. Without any marketing, enrollment, training, or advanced warning to providers, the health plans implemented the new process and experienced instant cost-free provider adoption. Ninety-seven percent of the initial faxed requests were received, imaged, and matched automatically.

According to Danita Mills, lead claims processor, BlueCard Operations at BCBSNC, “I processed a request from a home plan this morning, sent the physician's office a request for the record, got their response back online in Covisint’s ProviderLink, and forwarded it on to the home plan all in the same day. This has never happened before!”

Improved Provider Relations. Providers no longer needed to call to see if BCBSNC received their records. Users were able to see when the records were received and who processed them. The number of lost and misrouted responses was nearly eliminated, as the documents now moved electronically and had an audit trail that both the sender and the recipient could see. This audit trail created accountability for both the sender and the receiver, which helped eliminate the frustration caused over not knowing where the form was in the process and who had the next action step.

Reduction in Printing, Handling, and Distribution Costs. Several payers had reported handling and supply costs of $12 to $16 per claim attachment request. This cost included staff time, printing, postage, imaging, and manual matching of attachments. Printing the request letter alone, on average, was costing eleven cents per page (transaction). BCBSNC was able to avoid all cost associated with printing, postage, and imaging. Over time as providers continue to adopt the automated process, faxes will be replaced by more and more online transactions. In fact, every sent fax-request page reminds providers that they could be using the online process rather than the fax-back pages. The process not only creates immediate practical value, cost savings, and process improvement, it is also a vital marketing approach and migration strategy to drive provider adoption.