Blue Cross and Blue Shield of Kansas City Implements AWD

When Blue Cross and Blue Shield of Kansas City (BCBSKC) chose to implement the Automated Work Distributor™ (AWD®) from DST, they were looking to establish a more efficient and fraud-resistant infrastructure and fulfill approaching HIPAA deadlines. “We selected AWD based on its ability to provide an end-to-end solution—from imaging to comprehensive business process management,” said David Gentile, senior vice president of operations for BCBSKC. “Also, DST’s experience with AWD in their own financial services outsourcing operations enables them to understand the nature of regulatory compliance and to offer guidance in creating efficient, secure information infrastructures for their clients.” With AWD, BCBSKC now has a streamlined system to improve productivity by using predefined business rules to route work to appropriate processors and automated systems, enhance service and patient care with instant, simultaneous and secure access to information, and reduce revenue cycle days.

Challenge: Streamlining Claims Processing

Before AWD, paper claims were manually microfilmed for storage. The microfilmed claims were then distributed to BCBSKC’s processing units or their outsourced keying centers, which in some cases are hundreds of miles apart. This added significant cost and time to the process. After data was entered into BCBSKC’s two transaction systems, all data and corresponding documents were couriered back to BCBSKC. Reconciling these documents and ensuring the claim was entered correctly into the transaction systems added more time to the process.

Solution: AWD Business Process Management

With AWD, BCBSKC has a secure, automated system for delivering work to the appropriate processing area. Paper is scanned and electronic data feeds are automatically imported into AWD’s central information repository. AWD assigns each new claim with a unique ID to ensure that only authorized individuals have access to it. AWD then moves the claim into a predefined queue where it waits to be reconciled with data entry work resulting from steps later in the process. At the same time that AWD sends the claim to its queue, it determines where to send it for processing: to an in-house BCBSKC associate or to their third-party outsourcer for data entry. AWD automatically delivers an image of the claim to the appropriate step, reducing claim delivery cycle.

Facilitating Teleprocessing

AWD seamlessly transfers the electronic claim to the third party for data entry. The third party’s processors work at home, using their imaging technology to display the claim and perform data entry into BCBSKC’s transaction systems. Upon completion, the data-entered information is returned to AWD, which then matches it with the original, scanned claim waiting in the queue. This reconciliation step provides quality control to verify that the data entered into BCBSKC’s transactions systems matches the original claim. During this entire cycle, AWD ensures the claim is processed according to regulated time limits using BCBSKC’s aging and priority rules.

Tracking Incomplete Claims

AWD also helps to ensure accurate processing of incomplete and incorrect claims, reducing the time spent researching them from days to seconds. The image of an incomplete claim can be updated with comments and codes to explain why it is being returned. Then when a customer contacts BCBSKC to check on the claim’s status, customer service can instantly explain why it was returned and how it should be fixed. This also enables BCBSKC to track the causes of incomplete claims and make preventative adjustments.

Privacy Measures

BCBSKC is currently implementing printing restrictions to decrease the possibility of unauthorized access to information. They will also enhance the privacy of attachments, which are routed with claims as supporting documentation. AWD will assign these attachments, such as hospital records, with very specific levels of security.

Outsourcing the Infrastructure

AWD has become a mission-critical application for BCBSKC. Realizing that this would be the case, BCBSKC chose to outsource its server and application operations to DST’s AWD Data Center. The AWD Data Center provides real-time disaster recovery through DST’s redundant data centers and provides all systems maintenance and back-end functions, allowing BCBSKC to focus on their core business.

Blue Cross and Blue Shield of Kansas City (BCBSKC) provides healthcare benefits to more than 830,000 members in a 32 county region. The company provides a variety of health plan options, including two HMOs and two PPOs. BCBSKC has 1,100 employees located primarily in Kansas City, Missouri. BCBSKC is an independent licensee of the Blue Cross and Blue Shield Association