Case Study
Infosys BPO partners with a large Blue Cross Blue Shield organization to
improve efficiency and cost savings in Provider File Management process
This case study highlights how Infosys BPO helped a large Blue Cross Blue Shield
organization to improve their provider data maintenance process and achieve
significant improvement in efficiency, productivity and cost-saving.
The Client
The client is a large Blue Cross Blue
Shield health plan which provides health
insurance to over 3.6 million members.
The health plan provides a wide variety of
health and dental insurance products and
services, including Medicare and Medicaid
products for businesses and individuals.
The health plans include:
• HMO (Health Maintenance Organization)
• PPO (Preferred Provider Organization)
• POS (Point of Service)
• Direct Access (Open Access)
• Traditional Indemnity Plans
Business Situation
The client was facing several challenges
such as maintaining provider data across
• Evolved a task tracking mechanism
on healthcare basics and basic system
(based on associate, application, activity
navigation - Infosys also conducted
multiple databases, platforms and legacy
type, productivity, TAT and Quality) to
cross-training across multiple
systems, high risk of erroneous claim
identify root causes for any issues and
activities & applications in order to
processing, high provider and member
put in place innovative solutions to
ensure effective management of any
dissatisfaction and a steep rise in volume of
address the same
fluctuating volumes across request
complaint calls to the Customer/Provider
Support Service. In addition to mitigating
• Instituted a process in which Infosys
associates conduct additional research
these challenges, it was required to reduce
on change requests using authorized
the backlog significantly from the current
online resources before sending the
level of 30 days to a target of 5 business
same to client for clarification thus
days. The process includes administration
minimizing time required from client
and maintenance of provider/practitioner
subject matter experts
records in Portico and two other
mainframe based legacy systems. The key
sub-processes are provider activation,
Knowledge Management & Training
• Established a knowledge management
team to create detailed process
termination, demographic changes,
documents and check-lists to ensure
specialty changes, Group/Affiliation
rapid training and application of the
changes and managing any additional
change requests.
concepts into live-production
• Quickly ramped-up resources leveraging
an onsite-offshore training model
The Infosys Solution
via WebEx which led to significant
reduction in process transition timelines
Operations
• Studied the client business processes
in detail, identified the gaps and
shortcomings in processing
External Document © 2014 Infosys Limited
and cost. The resources were trained
across 3 different provider databases
•
Eliminated any investments from
client towards training Infosys FTEs
types in the future. This minimized the
risk of process knowledge loss
Quality
• Invested in advanced quality
auditing techniques and leveraged
Infosys quality tools to ensure high
quality delivery
• Frequent knowledge calibration and
mentoring sessions
• Process checklists to ensure compliance
to process steps
• Creation of a quality awareness culture
within the engagement
• Instituted a quality process in which
a reconciliation of Portico with other
applications is done for all change
quests. (Infosys has over 5000
Healthcare professionals across IT and
BPO with more than 3000 professionals
AHIP certified.)
Cleared the backlog accumulated over 5 months, lowered cost of operations
Score of Provider Files Aging (over 5 business days) reduced from 75% to 17%
Total Provider Files Inventory reduced by 90%
Continuous improvement in Provider Data Quality Index (PDQI) score to 99%
leading to number 1 position in the Health plan peer group
Faster and timely disbursements, higher provider satisfaction, reduction in
provider calls
Significant productivity improvement, eliminated risk of erroneous
claims processing
Client
Speak...
Manager,
Provider Administration
“We have realized great results over the past years. Infosys
continually demonstrates a high level of production and
quality, while offering long term solutions to improve
processes. Our efforts have increased our physician
and member satisfaction which is evidenced by the
improvement in our PDQI score. We look forward to
continued successes.”
External Document © 2014 Infosys Limited
About Infosys
Infosys is a global leader in consulting, technology and outsourcing solutions. We enable clients, in
more than 30 countries, to stay a step ahead of emerging business trends and outperform the
competition. We help them transform and thrive in a changing world by co-creating breakthrough
solutions that combine strategic insights and execution excellence. Visit www.infosys.com to see
how Infosys (NYSE: INFY), with $8.25B in annual revenues and 160,000+ employees, is Building
Tomorrow's Enterprise® today.
Infosys BPO, the business process management subsidiary of Infosys, provides a broad range of
enterprise and industry-specific services. We deliver transformational benefits to clients through our
proprietary Process Progression ModelTM (PPM). These benefits include cost reduction, ongoing
productivity improvements and process reengineering.
For more information, contact infosysbpo@infosys.com
www.infosysbpo.com
© 2014 Infosys Limited, Bangalore, India. All Rights Reserved. Infosys believes the information in this document is accurate as of its publication date; such information is subject to change without notice.
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