BCBSNC, WakeMed Collaboration Shows Success in First Year

RALEIGH, N.C. — Journeying through today’s complex health care payment system can be frustrating, sometimes leading patients to spend their energy dealing with administrative red tape instead of concentrating on what matters most – getting better. Today marks the one year anniversary of a Blue Cross and Blue Shield of North Carolina (BCBSNC) program that enables some of its Triangle-area customers to focus more on their health and less about their paperwork.

BCBSNC’s “Onsite Service Model” collaborative, launched one year ago as a pilot program with WakeMed Health & Hospitals, physically places Blue Cross service professionals alongside the hospital’s business operations staff. WakeMed’s claims professionals personally work with BCBSNC to resolve claims issues, answer questions and provide a more rapid response to patients. The one-stop shopping approach benefits patients by encouraging open communication between the organizations paying for and providing their care. The collaboration is the first of its kind in North Carolina.

“Blue Cross is committed to making North Carolina’s health care system work more efficiently, and improving customer service is an important step in that direction,” said Ian Gordon, senior vice president for Commercial and Government Operations for BCBSNC. “We’re literally sitting side-by-side with WakeMed, working together in a new way that helps both hospital and insurer but, more importantly, gives our customers peace of mind when they’re vulnerable and need it most.”

Evaluation is ongoing, but early results from the program’s first year show significant efficiency gains, including:
  • More than half of all BCBSNC claims inquiries at WakeMed were resolved on the first day they were received – an improvement of nearly 23% from just one year before. 
  • The number of complex and secondary claims submitted via paper has decreased by more than half, replaced with faster, more efficient electronic claims.
“Blue Cross and Blue Shield of North Carolina insures a significant number of our patients, and having representatives in-house has streamlined and improved the claim approval process,” commented Becky Andrews, WakeMed Vice President of Finance.  “Efficient claims resolution benefits not only BCBSNC and WakeMed, but also the beneficiaries and patients we serve.  We expect the collaborative effort with BCBSNC to continue yielding process improvement for both parties.”  

Based on the promising results shown at WakeMed, BCBSNC plans to expand the collaborative model approach. UNC Hospitals implemented its own onsite service collaboration with BCBSNC in December 2009, and additional physician practices and hospital systems across the state will be considered during 2010 and beyond.


About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 77 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at bcbsnc.com.
 
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