BCBSA – TPA Case Study
Customer Overview
(Our customer requested to remain anonymous to protect a competitive advantage)
This TPA provides Short Term Disability (STD), Long Term Disability (LTD), and FMLA management services in the US market.
Case Study
The company needed a disability claims system to manage the life cycle of a claim from intake to payments. They were looking for a solution to manage their existing customers and a platform by which they could grow their business.
The TPA provides disability management services for nearly 50 plans in an environment that is constantly changing and subject to complex state and federal regulations. It operates in a market where competitors are frequently offering new products and services to remain competitive. The company was relying on a legacy product that could not keep pace with their requirements, had limited medical management capabilities, poor reporting, numerous hand-offs, and required double entry for payments.
The TPA was looking for a claim management solution to:
- Improve efficiency and effectiveness of claim determination, medical management, payments, and operational reports
- Reduce costs of the claim operation
- Improve effectiveness of decision making
- Improve worker productivity and prioritization
- Support their business growth plan
After completing a market survey and considering a number of alternatives the TPA determined that ClaimVantage provided the solution that met their requirements. The TPA implemented the ClaimVantage Solution disability product in eleven months. The company streamlined their claim management process and implemented more than 100 automated workflow tasks that greatly improved the efficiency of case management.
The company also implemented standard measures for claim activities, turnaround times, and customer service to proactively track and report on case management metrics. Worker productivity increased significantly using the ClaimVantage Solution workflow and task management functionality. This has lead to a reduction in administrative support resources.
Decision-making was improved by providing the Case Managers with on-line claim information including tasks, notes, documents and correspondence. Operational reports that used to take two days to produce were automated and made available to the Claim Analyst in real-time. The TPA realized that they needed to invest in their claim solution to be competitive. They made the investment and began realizing the benefits immediately.
The current claim management system will support over 20 users with an additional 25 casual users that will have access to the system to perform certain tasks.
