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Blue Cross Blue Shield of Michigan

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

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Technologies Used

Informatica MDM

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.

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Business Need

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.

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Challenges

Current ICD-9 code sets are outdated and can’t accommodate new procedures and diagnoses.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.

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Solutions & Results

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.

Success Stories

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Western Union

Western Union built a data platform based on Hadoop and Informatica Big Data Edition

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Citrix

Citrix uses Informatica solutions to gain complete customer insight on all products

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M.D. Anderson Cancer Center

Informatica empowered scientific and clinical collaboration at this renowned cancer center by turning data into knowledge and facilitating self-service business intelligence