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HEALTHCARE

Health Plan Reduces Operations Complexity and Cost


The Challenge

Excellus BlueCross BlueShield’s multiple legacy mainframe platforms for dental processing were stunting the growth of its dental business. The outdated and labor-intensive platforms limited its ability to create innovative product and service offerings in the dental market space. The health plan needed a solution that would reduce operational complexity by removing the legacy IT systems from the process, eliminate dual maintenance for group and membership data, and consolidate resource skillsets on one platform.


Our Approach

Excellus migrated all dental business to its existing TriZetto® Facets core administration platform by implementing the Facets Dental module. To provide near-real-time response on eligible claims, it implemented Real-Time Claim Processing Services with integrated dental clearinghouse functionality. By leveraging the Facets supplemental applications, the health plan successfully consolidated and modernized multiple applications into a single integrated solution that streamlines dental processes to improve both performance and the member/provider experience.

Integrated Solution Achieves Business Objectives and Improves Metrics

Even as operational metrics are still being optimized, Excellus expects a reduction in overhead and maintenance costs once the legacy systems are fully retired. The combination of Cognizant healthcare solutions and Facets integration has already shown significant results: After migrating approximately 673,000 members (along with associated groups and rates) to Facets over 17 months, the health plan has achieved production load success rates at or above 99% on each load. The first pass rates for dental claims have increased by 20%, and the health plan has integrated membership setup across products. By offering subscribers a one-stop shop for dental and medical plans, as well as a single view of their benefits, Excellus is now strongly positioned to grow its dental business.

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At or above 99%

production load success rate per load

~673,000 members

migrated to the Facets platform over 17 months

One integrated solution

streamlines dental processes

20% increase

in first pass rate for dental claims


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