Blue Cross Blue Shield of Michigan (“the Blues”) administers health benefits to more than five million members residing in Michigan.
“With all of the technology changes that have occurred in medicine in the past 30 years, the sheer volume of the codes made it mandatory that we have data easily accessible in a user-friendly manner.”
— Dennis Winkler, IT Director, Blue Cross Blue Shield of Michigan
Multidomain Informatica MDM improves operations by empowering business users with consolidated and reliable business-critical data—such as customers, products, channel partners, suppliers—and the relationships between data.
Comply with Federal government mandate requiring the health care industry to update the codes used for diseases and conditions.
Ensure patient benefits are handled expeditiously and claims are paid with minimal paperwork.
Current ICD-9 code sets are outdated and can’t accommodate new procedures and diagnoses. ICD-10 codes contain more clinical information and updated terms needed for advances in technology and medicine.
The Blues needed to upgrade from 16,000 codes to 150,000 codes, each mapped to diagnostic categories and benefits.
The ICD-10 transition is a large, complex change for everyone involved and impacts nearly all areas of the business. Disruption in the system could affect cash flow, member and patient benefits.
Informatica MDM stores ICD-10 codes in a single business process management layer, allowing the latest codes to be added quickly, cost-effectively and transparently, with no impact to patient safety, care delivery, or provider reimbursements.
The Blues was able to build a single, centralized hub for diagnosis and procedure data, populated by an “encyclopaedia” of ICD-9 and ICD-10 codes, that will become the sole source of truth for the organization.
The use of ICD-10 will improve the ability to measure healthcare services, enhance the ability to monitor members’ health, and decrease the need for supporting documentation when submitting claims.
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