CASE STUDY
Industry:
Health Insurance
Products / Services:
Revenue360
Revenue reconciliation for a leading Multi-state Health Insurer
Client Background
Client is one of the largest health insurer in the United States highlighting its unique position as a customer-centric healthcare organization. It operates Blue Cross and Blue Shield® Plans in the USA. The company serves nearly 20 million members across five states.
Client Requirements
With members across 5 states, the client faced issues with Membership Reconciliation and improving the overall Operational efficiency. The client demanded Multi-State Regulatory and CMS changes with an oversight into Financial Reconciliation for both Medicare and Medicaid line of businesses (LOBs).
Engagement Highlights
30%
Increase in
Operational Efficiency
5 states
Multi-state
Regulations
Multiple-Line
Business
Operational enterprise governance for both the Medicare and Medicaid lines of business
Audit
Support
Standardized and detailed Member level analytical reporting with audit support functionality
Automated
Workflows
Highly automated configurable workflow for managing Discrepancy life-cycle
Solution Highlights
With an aim to increase the overall operational efficiency across multiple line of businesses, a fully automated reconciliation solution was implemented for the customer. Transformational Initiatives along State and CMS Regulatory Changes were implemented to ensure compliance.
Enterprise
Solution
Enterprise solution that handles both Medicare & Medicaid lines of business
Single
Platform
Successfully incorporated the regulations of all five states into a single platform
Data
Integration
Integrated both CMS and state data in a single comprehensive system
Automated
Reconciliation
Streamlined & Automated process for membership reconciliation, establishing an efficient and seamless system
Membership
Financials
Top to granular view of membership financials providing holistic understanding of financial performance
CMS
Compliance
Reports and submission capabilities adhere to specific requirements set by CMS, ensuring compliance
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