HealthNow New York Inc. Empowers Business Users to Drive Improvements in Claims Processing and Increase Member Retention and Loyalty

CAMBRIDGE, MA – April 13, 2009 – HealthNow New York is using Pegasystems (NASDAQ:PEGA) to optimize its claims management process and hold down premium rate increases. By upgrading to Pegasystems’ latest Build for Change® technology, the leading New York health insurer will enable their business users to capture and drive business improvement ideas and goals quickly and more effectively. 

This new initiative for HealthNow drastically reduces the lag time between business intent and solution delivery.  HealthNow is now able to enhance the speed and responsiveness of new productivity improvement ideas, ensuring quicker benefits to end customers, including members, physicians and regulators.  The deployment of Pegasystems’ latest Build for Change technology across three claims related applications is expected to take less than five months, and is intended to improve service delivery, decrease administrative costs and minimize manual coding.

“HealthNow is focused on delivering the highest quality products and services to our members. We also want to simplify processes for our employees. Pegasystems has been a trusted partner of ours in these efforts,” said Paul Stoddard, vice president and chief information officer at HealthNow.  “The deployment of the Pegasystems’ healthcare solution frameworks for claims repair and management will allow us to accelerate innovation, drive greater productivity and ensure that our customers receive outstanding service.”

"HealthNow continues to show exemplary commitment to its customers by enhancing its services through advanced and innovative use of technology,” said Elizabeth Hart, senior director of Healthcare Solutions at Pegasystems.  “The new initiatives at HealthNow will provide a stronger platform to further streamline their claims processing operations and achieve new levels of business success and customer satisfaction.”

HealthNow is utilizing multiple Pegasystems’ healthcare solution frameworks to jumpstart these initiatives.  Pegasystems BPM solution frameworks are pre-configured to industry specific best practices and enable users to quickly get new BPM solutions up and running to drive business transformation.  Pegasystems’ Claims Repair solution framework improves straight through processing, reduces claims inventories and shortens development time for new edits. It also provides pre-packaged best practice claim edits for improving auto-adjudication of claims. The system receives targeted claims utilizing HIPAA compliant claims message handling, then researches, corrects and submits them for finalization.  


The second new BPM solution framework being used by HealthNow, Pegasystems’ Claims Workstation+, drives dynamic claims management, eliminates claims backlogs and improves operator productivity. It prioritizes, escalates, and routes pended claims to operators for finalization, optimizing work distribution and skill matching for intelligent claims inventory management.



About HealthNow New York

HealthNow New York Inc., headquartered in Buffalo, New York with annual revenues exceeding $2 billion, is one of the leading healthcare companies in Upstate New York. Through its divisions, HealthNow provides access to quality health care and innovative wellness solutions for more than 815,000 members. It is the parent company of BlueCross BlueShield of Western New York, BlueShield of Northeastern New York, HealthNow (in Central New York), MedUS LLC in Binghamton, NY, and Brokerage Concepts, Inc. in King of Prussia, PA.

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

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The information contained in this press release is not a commitment, promise, or legal obligation to deliver any material, code or functionality. The development, release and timing of any features or functionality described remains at the sole discretion of Pegasystems, Pegasystems specifically disclaims any liability with respect to this information.


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