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Claims Validation System by CGI and Regence Enhances Provider Relationships
CGI and The Regence Group are pleased to announce release of the CLEAR™
(Clear
Logic Edits And Rules) tool, a claims validation system with a unique
open-knowledge
base that shares claims edit rules with providers to help them manage
claims
submissions more effectively. Historically, edit rules have been held
proprietary by
software vendors that develop these systems.
What CGI and Regence provide
Working with Regence, CGI has developed a “clear” claims
review and validation system with an open standard that shares edit rules
with the provider community, that allows health plans to review claims
in a pre- or post- payment environment, and offers flexibility to accommodate
specific claims adjudication systems and processes as well as reimbursement
policies.
A team of reimbursement experts, technology professionals, clinical coders
and
physicians worked for more than two years to develop the groundbreaking
system.
CLEAR’s “open source” approach directly responds to heightened
provider community
interest in the claims review and code editing systems that health plans
employ to
ensure that the most appropriate provider payment is made. CLEAR delivers
a first-ofits-
kind compilation of nationally recognized rules for the correct coding
and
processing of claims, and provides Web-enabled access to the entire rule
set and source
material. The system, available through CGI, is a boon for health plans
that want a
highly credible claims review system that will stand up to provider community
scrutiny.
The system will continue to be implemented sequentially in all Regence
plans in Idaho,
Oregon, Washington and Utah.
CGI domain expertise
Robert Haskey, M.D., a Regence medical director, said: “We’re
excited about partnering with a firm that has such extensive knowledge
and expertise in this area. CGI is a national leader in developing claims
validation software systems, methodologies and tools for healthcare payers.
They have earned credibility in the payer community, having worked with
more than one third of Blue Cross Blue Shield Plans nationwide. Integrating
their solutions with our research and internally developed tools creates
the right solution that we feel is fair, yet comprehensive.”
Jon Grandstaff, principal of CGI said: “In addition to being one
of the largest and
strongest healthcare payers in the U.S., Regence has spent thousands of
staff hours
developing additional knowledge bases through their own analysis, expertise
and
research. By combining our strengths, we have developed an effective claims
validation system that fosters more productive relationships with providers.
We are
confident that it is the strongest product of its kind available to healthcare
payers
today.”
About Regence
The Regence Group is an affiliation of four leading Blue Cross and/or
Blue Shield companies in the northwest and intermountain states: Regence
BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross
BlueShield of Utah and Regence BlueShield in the state of Washington.
Collectively, Regence serves more than three million members, generates
more than $5 billion in annual revenue, and has over 23,000 provider relationships.
About CGI
Founded in 1976, CGI is the fourth largest independent information technology
services firm in North America, based on its headcount. CGI and its affiliated
companies employ 14,600 professionals. CGI’s annualized revenue run-rate
totals $1.3 billion. CGI’s order backlog currently totals $6.7 billion.
CGI provides end-to-end IT services and business solutions to more than
3,000 clients worldwide from more than 60 offices. CGI’s shares are
listed on the TSX (GIB.A) and the NYSE (GIB).
Web site: www.cgi.com.
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