Core Administration with HealthEdge®

At Blue Cross and Blue Shield of Nebraska (BCBSNE), we are continually evolving to better support providers and deliver more for our members, while lowering costs and maximizing operational efficiency. The HealthEdge Solution Suite positions us to nimbly navigate regulatory changes, value-based care, growing business needs and more. 

Why HealthEdge?

BCBSNE chose to upgrade its core claims administration platform and operations to HealthEdge’s HealthRules® Payor based on its advanced technology, dedicated service model and clear commitment to ongoing innovation. 

The highly configurable nature of the conversational, rules-based system promised BCBSNE flexibility to navigate industry dynamics and business demands with greater speed and confidence. One of the big drivers was BCBSNE’s commitment to leading the way in Total Care – supporting providers in the transition to value-based (vs. fee-for-service) reimbursement, lowering costs of care and measurably improving members’ health outcomes. 

“HealthRules’ configurability paves the way for us to take Total Care further and faster,” said Susan Courtney, Executive Vice President, Operations and Clinical Effectiveness. “We are committed to partnering with providers to deliver more for members, and this gave us a foundation to do that.”

Implementation and Immediate Impact

BCBSNE had an aggressive timeline to go live with HealthRules Payor within two years. The core platform change required full commitment from the organization to enable the transition, embrace new ways of working and thoughtfully bring customers along.

The BCBSNE team took care to create modular, reusable components in HealthRules – like interchangeable building blocks – so new solutions could be designed, built and scaled in a matter of days, compared to the weeks or months it may have taken previously. 

This configurability was put to the test with COVID-19 and passage of the federal Coronavirus Aid, Relief and Economic Security (CARES) Act in March 2020. Effective immediately, new regulations around payment for COVID-19 testing, treatment and telehealth services demanded compliance; the longer it took plans to react, the more customer abrasion and administrative costs they would incur. 

Fortunately for BCBSNE members, the team implemented changes to the HealthRules Payor platform within 72 hours and has been able to consistently get new codes into production within 24 hours, as regulations evolve.

Learn more about HealthEdge and HealthRules Payor »