Blue Cross Blue Shield of Minnesota Increases Claims Processing Efficiency and Flexibility Through Pegasystems’ Technology

CAMBRIDGE, Mass. – September 9, 2008 – Blue Cross Blue Shield of Minnesota (BCBS MN) is deploying Pegasystems’ Claims Repair Solution Framework™ (NASDAQ: PEGA) to address new Blue Cross Blue Shield Association compliance mandates, boost productivity and increase accuracy across their claims operations.  By using the Pegasystems’ solution, BCBS MN is improving reusability across the enterprise and reducing the time, cost and effort involved in achieving claims compliance.

Pegasystems' Claims Repair  is pre-packaged business process management (BPM) software containing an extensible library of claim edits, HIPAA 837 claim message handling, and best practice pre-adjudication workflows.  The solution automatically receives, enriches and prepares claims so they can be adjudicated by core payer systems thereby improving straight through processing, reducing claims inventories and saving operational expense. 

Claims Repair will help BCBS MN meet Blue Cross Blue Shield Association claims mandates that become effective this October.  Aimed at increasing provider satisfaction, the BCBSA mandates remove provider claim-filing restraints by requiring accommodation of claim submissions with larger numbers of claim lines, more precise dollar amounts and more specific units of service.  By deploying Claims Repair, BCBS MN expects to achieve compliance by the deadline plus also receive additional value through automating their pre-adjudication claim edits.

“As a leading healthcare organization dedicated to customer service, we have taken a strategic approach to the use of technology across our operations,” said Laurie Clark, vice president, Business Design & Enterprise Transactions at BCBS MN. “We have used Pegasystems technology to implement a Common Transaction Framework across multiple areas and now are expanding our relationship by deploying Claims Repair to further automate our claims processing.”

“When we wanted to extend the system to new areas, we did a full analysis and found that Pegasystems’ Claims Repair would give us the quick time to market and functionality we needed to further automate claims servicing,” continued Clark.  “Our strategy – and Pega’s software capabilities – positions us well to drive productivity across our claims business and ensure outstanding customer satisfaction.” 

”With its strategic use of technology to achieve business goals, particularly in the areas of productivity and customer service, BCBS MN is raising the bar for other healthcare organizations,” said Elizabeth Hart, senior director of Healthcare Solutions, Pegasystems. “BCBS MN has set up BPM best-practice groups within their organization, and they have a clear vision for highly effective end-to-end servicing on which they’re executing with impressive results.”

About Blue Cross and Blue Shield of Minnesota

Blue Cross and Blue Shield of Minnesota, with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota’s first health plan and continues to carry out its charter mission today: to promote a wider, more economical and timely availability of health services for the people of Minnesota. A nonprofit, taxable organization, Blue Cross is the largest health plan based in Minnesota, covering 2.9 million members in Minnesota and nationally through its health plans or plans administered by its affiliated companies. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago. Go to www.bluecrossmn.com to learn more about Blue Cross and Blue Shield of Minnesota.

 

About Pegasystems

Pegasystems (NASDAQ: PEGA) develops strategic applications for marketing, sales, service, and operations. Pega’s applications streamline critical business operations, connect enterprises to their customers seamlessly in real-time across channels, and adapt to meet rapidly changing requirements. Pega’s Global 3000 customers include many of the world’s most sophisticated and successful enterprises. Pega’s applications, available in the cloud or on-premises, are built on its unified Pega 7 platform, which uses visual tools to easily extend and change applications to meet clients’ strategic business needs. Pega’s clients report that Pega gives them the fastest time to value, extremely rapid deployment, efficient re-use, and global scale. For more information, please visit us at www.pega.com.

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