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8 January 2010 | Healthcare Finance News

A report on Blue Shield of California’s success using MedeAnalytics’ Claims Transparency solution:

“Blue Shield of California and network hospitals that have deployed its Partnership in Operations Excellence and Transparency (POET) have seen a reduction in administrative costs.

“The claims transparency program has resulted in a decrease in the number of claims appeals and disputes, said Juan Davila, senior vice president of BSC’s network management.

“Overall, the length of time a claim is paid once BSC receives it has been reduced from 10 days to 8.2 days. Additionally, there is less back-and-forth communication over claims disputes.

“Lack of access to information is the culprit of claims problems, said Davila. With POET, BSC can show network hospitals detailed summaries of their claims data, which helps identify root causes.

“…98 hospitals (are) participating…’ We decided to do this unilaterally to improve relationships with providers,’ he said. ‘The beauty of being transparent is nothing is hidden; it builds trust.’”

Source: Patty Enrado, “Calif. Blues’ POET program delivers results," Healthcare Finance News, Jan. 8, 2010, http://www.healthcarefinancenews.com/news/calif-blues-poet-program-delivers-results.

“The claims transparency program has resulted in a decrease in the number of claims appeals and disputes”

Juan Davila

Senior Vice President
Blue Shield of California