CASE STUDY
Industry:
Health Insurance
Products / Services:
EDPS-GT360
Managing and transforming one of the largest BCBS Organization in the USA
Client Background
Client is one of the largest health insurer in the United States highlighting its unique position as a customer-centric healthcare organization. It operates Blue Cross and Blue Shield® Plans in the USA. The company serves nearly 20 million members across five states.
Client Requirements
With members across 5 states, the client faced issues with Encounter Data Processing and submission. The requirement was to receive, process and reconcile encounter data from various sources and ensure regulatory compliances.
Engagement Highlights
30+
% Increase in Operational Efficiency
5 states
Multi-state
Regulations
98%
CMS Acceptance
Rate
Solution Highlights
Wipro’s EDPS-GT360 integrates and processes the encounter files in various formats, performs seven levels of compliance checks through integration with Wipro's analytical platform. The CMS compliant solution maximizes reimbursement, reduces administrative costs and improves accuracy.
Valuable
Data Insight
Identify HCC opportunities based on CMS models, chart data and comparing compliance edits with various files.
Improved
Accuracy
Reduce number of rejected claims by leveraging Wipro compliance checker, a pre submission verification engine.
Audit
Preparedness
In-depth reporting, tracking and analytic capabilities for reconciliation process and mitigation of risk exposure
Flexible Inbound
File Format
837 5010 X12 and proprietary data sources converted to HIPAA compliant CMS Outbound 837 X12 files
Reduced
Cost
Integrated solution with Medicare Advantage/ Medicare Medicaid Plans within one UI. Ensures more efficiency and flexibility
CMS
Compliant
Successfully created reports and submission capabilities adhered to specific requirements set by CMS, ensuring compliance
Modernization of a leading BCBS Health Plan
Wipro implemented end-to-end BPaaS platform with Enrollment, Membership, Agent commissions and Encounters.
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Leading Medicare Advantage Start-up Plan Implementation
Wipro helped achieve growth objectives and addressed the pressing business needs for a Medicare Advantage
Health Plan.
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