Large Healthcare Provider Reduces Turnaround Time by 33 Percent

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The client is a large US Blue Cross plan provider, which needed to transform itself to keep up with the changing healthcare environment and the increase in competition within the field. The client wanted to initiate processes, which would transform the business and enable participation in public exchanges.



The growing competition in the field of healthcare, combined with slower time to market for planned products, forced the client to seek out newer customer service channels. Legacy Electronic Data Interchange (EDI) and core applications with high operating costs led to inaccurate, inconsistent, fragmented, and voluminous data. The client turned to Mphasis for a solution.



Our team devised a solution that covered:

• Modernizing systems

• Implementing the product

• Establishing meeting mandates

• Optimizing operations


The solution enabled the client to:


• Complete 100 percent of mandates on time with zero penalties

• Streamline integration with exchanges in a timely manner, which led to 30 percent of enrollment on exchange share in the state

• Implement Six Sigma and Lean methodologies

• Establish an information technology infrastructure library (ITIL) based on a 24X7 flexible support model

• Reduce Turnaround Time (TAT) by 33 percent for benefit plan setup

• Meet 100 percent of service-level agreements

• Enable newer application development such as Administrative Services Only (ASO) billing and operational data stores

• Integrate with tools such as NetworX pricer and Claim Xten

• Establish a single source of truth enterprise data warehouse (EDW) for a consistent and unified view

• Accomplish EDI product transition and implementation from SeeBeyond to EDIFECS

• Support and integrate with facets implementation