Blue Cross Blue Shield of Nebraska
The Problem:
Blue Cross and Blue Shield of Nebraska, a health insurance provider was having a problem with attribution of claims to policy holders. With federal regulations an incorrect correlation would cost them tens of thousands of dollars. The backlog of unmatched information exceeded 2 years. During that time the claims were going unpaid and doctors were leaving the plan.
The Solution:
Contemporary Analysis (CAN) built a solution that looked for matching data points. As the system eliminated obvious matches it continued to connect data points until it paired down the data to a few unknowns. The results were then reviewed by a person to verify or disqualify the results that were inconclusive. Once implemented the system runs in real time and the anomalies are reviewed as part of a regular routine.
The Results:
- The backlog has gone from 2 years to a few hours of manual review each month.
- The system has had a 99% success rate in attribution.
- The insurance provider was able to reduce losses from unattributed claims.
- Staff is now able to focus on additional areas of their business rather than dedication to a single project.