Case Studies - Blue Shield

Hospital Facilities Tracking Application.

Challenge

With 2.7 million members and $6 billion in annual revenue, Blue Shield is the state's third largest health plan. Founded in 1939 and headquartered in San Francisco, Blue Shield is a not-for-profit corporation with approximately 4,200 employees and more than 20 offices throughout California.

Blue Shield identified need to build the on-line contract management application based on the existing Access modules. The purpose of this application is to be a single source processing aid for the facility claim processors to replace the need to review and interpret complicated hospital contracts and subsequent iterations.

Pamet's Solution

Pamet created HFCA application that centralizes every aspect of the contracting process into one easily accessible, online location. Contractors are guided through the contract preparation process, while system offers abilities for preventing duplicate contracts. Each contract can be very complex since it can include large number of services and related rates. Thus, Contractor can spend up to 4 hours preparing a single contract. Once the Contractor completes the job, contract gains pending status, and afterwards, Approver has to review and approve or reject contract.

Benefits to the Client

HFCA streamlines contracting process, making operations of the human resources more efficient, thus reducing the organization's workload for Contractors and Approvers. Retrieving, storing, and maintaining all the hospital contracts in various locations is now less time consuming and more efficient. Clarification of processing instructions is now guided by the defined system, and the legal language used in contracts is consistent. This resulted in avoiding processing differences and incorrect payments.

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