Improved Payer Relations 

Improving Payer Relations - Closing BCBS Reciprocity Reimbursement Gaps

The largest for-profit member of the Blue Cross Blue Shield Association was managing reputation risk due to a complaint filed with the state’s Department of Insurance. They were looking for a professional services partner to:

• Assess the current state of claims processing
• Identify key drivers of failure
• Implement solutions to avoid future failure

Solutions and Results

Tactegra designed a new process to facilitate BCBS reciprocity claims and expedite reimbursements while preventing opportunity for failure recurrence. After an exhaustive process decomposition, data mapping and performance analytics exercise, Tactegra identified failures and process gaps throughout the claims process. Both BCBS reciprocity process and the provider’s revenue cycle  back-end were optimized in a sustained manner as a result.

Improved Process Environment

New E2E accelerated claims process that appropriately recognizes BCBS reciprocity (Blue Card Program) with direct link to member’s actual plan.