Payers News Briefs

BCBS montana boosts ITs customer service                                       
Blue Cross and Blue Shield of Montana is boosting its customer service with technology from Cambridge, Mass.-based Pegasystems. BCBSMT has selected Pegasystems' Customer Process Manager for Healthcare to optimize its customer service, sales, and process efficiencies. Pegasystems' technology will streamline customer phone inquiries resolving many questions within the first call. The insurer plans to roll out the new technology in early 2009.

Shared Health integrates data, improves workflow
Shared Health, one of the largest public/private health information exchanges (HIE) in the United States, is using technology from Santa Monica Calif.-based Orion Health to integrate data and improve workflow.  Shared Health will implement Orion Health's Concerto Physician Portal to enable an integrated electronic health record system and provide access to patient data from disparate systems. Orion Health North America President Paul Viskovich says Shared Health is the first HIE to leverage Concerto's strengths in integrating health data and workflow applications in a unified, patient-centric view.

UPMC adds medical management technology
UPMC Health Plan, the second-largest health insurer in Western Pennsylvania, has expanded its partnership with Southborough, Mass.-based ikaSystems to improve quality and cost containment. UPMC will add Web-based integrated medical management solutions to its existing ikaEnterprise modules underlying its portal strategy, allowing the plan to enhance healthcare quality for its members while supporting providers with performance information.

FCSO employs new reimbursement system
First Coast Service Options (FCSO), headquartered in Jacksonville, Fla., is working with Alexandria, Va.-based Burgess, a Medicare reimbursement solutions provider, to support a new Medicare contract awarded recently by the Centers for Medicare & Medicaid Services. Under this new contract, FCSO will resolve reimbursement disputes beginning Jan. 1, 2009, between healthcare providers and organizations offering Medicare Private Fee-for-Service plans.  FCSO will license and employ the Burgess Reimbursement System to compute accurate pricing associated with disputed claims.