Blue Cross Blue Shield

Cutting Costs through automation

Riverbend Government Benefits Administrators was seeking to cut costs and automate the process of evaluating and paying nearly 10 billion dollars of Medicare claims each year. Under constant pressure from CMS to improve efficiency, lower costs per claim and increase accuracy, Riverbend needed innovative technology and expert guidance.

Working with Vega and IBM, Riverbend was able to leverage our deep knowledge of Claims processing and Medicare systems to implement a streamlined case management solution. The solution provides several unprecedented capabilities to their company. Tight integration to the Fiscal Intermediary Standard System (FISS) provided a modern web-based interface, dramatically reducing processing and training times, and reducing training times for peak processing periods. Overall processing times were reduced by over 30%, while claim resubmissions were reduced by nearly 50%.

The system markedly improved processing in the following areas: Provider enrollment, Claims & Adjustments, Credit Balance, Customer Service, Complaints, Provider Reimbursements, Provider Outreach, Audits and Medical Reviews.