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Casestudy-Claim Management Services Inc., U.S.A.
 
 
Claim Management Services, Inc. [CMS] founded in 1982, is a wholly owned subsidiary of Blue Cross & Blue Shield United of Wisconsin. Headquartered in Green Bay, Wisconsin, U.S.A. A nationally recognized third party administrator [TPA] of excellence, serving over 170 self funded plans ranging in size from 150 to over 20,000 employee lives nationwide. CMS has bagged SAS 70 Accreditation as an indication of their commitment to excellence.

Technology
ASP, MTS, IIS SQL server on Win NT/2000 platform.

Client's Feedback
Today our Client continues to be extremely satisfied with Clavib services. The Client now utilizes Clavib exclusively for maintaining their application and the data. Clavib has been able to deliver superior service to the Client on a consistent basis providing quality, timely support for the Client at an extremely cost effective rate by harness it's offshore model. There is always a win-win situation between our Client and Clavib.

Key areas
  • Our client process medical/dental/vision claims manually.
  • All the claims were required to manually maintained. It was a quite tedious process to handle and even the efficiency was a concern.
  • Cost per claim was increasing.
  • The company began considering outsourcing the development of software in order to
    Reduce and control the processing cost
    • Reduce the margin of entry errors
    • Add a scalable solution for peeks and expected growth
    • Achieve a quicker turn-around utilizing the global time difference.

The Clavib Solution
Clavib provided an offshore workforce to accomplish the product development and deployment. Clavib created a powerful Web-based solution for the client on tight budgets and demanding deadlines. Clavib's efficient and skillful team worked closely with several application owners to devise an user-friendly system that would provide Web-based application to installation and maintenance without the need for a lot of user interface or technical knowledge. Our team could bring out a secure, web-based interface to the end users. The application could handle the end user request in a Web-based environment and generated user specific information.

Value Perceived

  • Within in a short span of time the users at our CMS was fully trained, the technology link established and CMS started processing claims digitally.
  • Within 6 weeks:
    • CMS could process quiet a good number of claims per a week
    • The team exceeded the company's quality expectation by achieving less than 1% error rate
      The company lowered their processing costs by 60%
    • The team reached accuracy rates of Financial accuracy 99.45%, Payment accuracy 97.85%, Statistical accuracy 99.87%
    • All documents processed within 48 hours
    • Claim Management Services is capable of accepting and processing the electronic transaction formats mandated by HIPAA. Which include HIPAA's 837 electronic format for institutional, professional or dental claims.
    • A Total Quality Improvement Program, which mandates the continuous evaluation and improvement of health care outcomes.

 

 
 
 
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