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

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