Blue Cross and Blue Shield of North Carolina
Microsoft BizTalk Server Integration
“BCBSNC was growing from 5,000 to 30,000 claims being processed per day, which
meant they needed to increase the quality and accuracy of data. BizTalk Server allowed
them to do just that while also lowering costs and lead time.”
– Dan Michaels, Innovative Architects
“We worked with BCBSNC to develop an integration strategy using BizTalk Server
that would allow them to easily trade HIPAA claims and eligibility data with their
providers.”
– Rich McCraw, Innovative Architects
Overview
- County or Region: United States
- Industry: Healthcare/ Insurance
- Customer Profile:
Blue Cross and Blue Shield of North Carolina (BCBSNC) 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. The
company offers its members discounts and information on a wide variety of health-related
services at no additional cost.
- Business Situation:
In anticipation of receiving 30,000 claims per day as opposed to 5,000 claims, Blue
Cross needed to plan for their infrastructure to handle the significant increase
in claims. Blue Cross needed a system that is scalable, allowed communications options
internally and externally, lowered the cost and lead time for presenting new HIPAA
documents, and increase the quality and accuracy of data.
- Solution:
Innovative Architects and Blue Cross used Microsoft BizTalk R2 2006 to develop a
flexible integration strategy to easily trade HIPAA claim and eligibility data with
providers. The new system also took less time and reduced costs. Using BizTalk Server
supported a wide variety of protocols and transfer options as well as scalability
and reliability.
- Benefits:
• Reduced time an effort to onboard new partners
• Increased capacity and scalability
• Increased reliability and availability of critical services
• Expanded options for communicating with external healthcare providers
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Case Study
- Situation
BlueCross BlueShield of North Carolina (BCBSNC) was anticipating growing from 5,000
claims per day to 30,000 claims per day in 2008 and 2009 as it expanded existing
lines of business and worked to forge partnership with new customers. BCBSNC realized
they needed to strategically plan for their infrastructure to handle the significant
increase in claims per day.
Some of the challenges that BCBSNC faced were:
• An existing system that lacked the scalability needed to handle the increase
from 5,000 claims to 30,000 claims in processing load
• Restricted communication options -- both internally and with external healthcare
providers
• A need to lower the cost and lead time for presenting new HIPAA documents
and interfaces internally as well as externally to healthcare providers and customers
• A need to increase the quality and accuracy of data, while easing the management
of their partner interfaces
- Solution
BCBSNC, along with the expertise of the Innovative Architects team and Microsoft
BizTalk R2 2006 technology, developed a flexible integration strategy that allowed
BCBSNC to easily trade HIPAA claim and eligibility data with their providers. The
new system reduced the time it took to onboard a new line of business, while lowering
the cost to maintain the solution. By utilizing BizTalk Server, BCBSNC developed
a process that not only supported a wide variety of protocols and transfer options,
but also offered the scalability and reliability BCBSNC needed to handle growth
-- both expected and unexpected. The new solution allowed BCBSNC to handle an increased
load while serving their customers in new and innovative ways.
- Benefits
• Reduced time and effort to onboard new partners
• Increased capacity and scalability
• Increased reliability and availability of critical services
• Expanded options for communicating with external healthcare providers
- Software and Services
• Microsoft Windows Server
• Microsoft SQL Server
• Microsoft BizTalk Server
• Microsoft Visual Studio
• Microsoft .Net Framework
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