HealthNow New York Inc. Selects Pegasystems for Claims Exception Processing
CAMBRIDGE, Mass., Aug. 21, 2001 — As the healthcare industry increasingly recognizes the value of managing business processes within the context of an overall Customer Relationship Management (CRM) strategy, Pegasystems Inc. (NASDAQ: PEGA) today announced that HealthNow New York Inc. has purchased an enterprise license for claims exception processing, a component of PegaCRM Healthcare, Pegasystems' rules-driven process automation technology. Pegasystems' technology includes a robust workflow engine that actually performs tasks without manual intervention and Pegasystems' patented rules technology allows business users to implement strategic and operational directives in response to changing market and business needs. Pegasystems' technology will help HealthNow automate, route and process claims faster and more efficiently. HealthNow, a BlueCross BlueShield organization, is a leading health insurer in New York, serving over 750,000 members.
HealthNow is the fourth BlueCross BlueShield organization to select Pegasystems' rules-driven process automation technology. By providing a global connection to their legacy systems, PegaCRM Healthcare will give HealthNow the means to increase the speed and consistency of claims exception processing, as well as enhance staff productivity by reducing the number of manual processes and paper document handling. PegaCRM Healthcare allows HealthNow to help solve many customer service-related issues, thereby facilitating increased customer satisfaction and retention.
"Customers are our number one priority. We chose Pegasystems not only because of their success with other Blues, but also because of the process automation engine that maximizes the value of our back end claims systems," said Gary Kerl, CIO, HealthNow New York Inc.
"We are excited about streamlining our operations with Pegasystems' proven technology," said Sandi Johanson, Vice President, Claims Re-Engineering, HealthNow New York Inc. "We believe that adding process automation to our claims exception system will help support our strategic re-engineering initiative."
"PegaCRM Healthcare will help provide benefit to the full spectrum of customers at HealthNow," said Elizabeth Hart, Director of Product Management, Healthcare, Pegasystems. "More efficient resolution of claims will help increase both member and provider satisfaction, while automated workflow, with step-by-step instructions for business users will help increase HealthNow's employee satisfaction. This not only helps meet HealthNow's business goals, but also is an achievement for Pegasystems in expanding our presence in the healthcare market."
PegaCRM Healthcare Claims Exception, a rules-driven process automation solution, gives healthcare organizations the means to manage the full range of claims exception processing interactions, including skill-based routing, claims payment automation and exception research capabilities. PegaCRM Healthcare Claims Exception can be purchased as a stand-alone solution or as a value-added component of the larger PegaCRM Healthcare solution for integrated Customer Relationship Management (CRM).
At HealthNow, Pegasystems' technology will be running on AIX RS 6000 platform and Sybase, integrating with the existing Facets claims system.
About HealthNow New York
With revenues of $1.25 billion, HealthNow New York Inc. provides health coverage to approximately 750,000 New Yorkers. Established in 1936, HealthNow New York does business as Buffalo-based BlueCross BlueShield of Western New York, Albany-based BlueShield of Northeastern New York, and Binghamton-based Upstate Medicare Division. HealthNow New York offers a full range of healthcare coverages including PPO, POS, HMO, and indemnity plans.
About PegaCRM Healthcare
PegaCRM Healthcare, a rules-driven, multi-channel solution, enables organizations to manage customer interactions received through Web browser-based and Computer Telephony Integration (CTI) channels. Driven by a powerful, highly scalable architecture, it gives healthcare organizations the power to utilize rules to automate the business processes associated with customer care. PegaCRM Healthcare provides customer care while supporting HIPAA compliance strategies.
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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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