Blue Cross Blue Shield of Minnesota Increases Claims Processing Efficiency and Flexibility Through Pegasystems’ Technology

Business Editors/Health Editors/High-Tech Editors

CAMBRIDGE, Mass.--(BUSINESS WIRE)--September 9, 2008--Blue Cross Blue Shield of Minnesota (BCBS MN) is deploying Pegasystems’ Claims Repair Solution Framework TM (NASDAQ: PEGA) to address new Blue Cross Blue Shield Association compliance mandates, boost productivity and increase accuracy across their claims operations. By using the Pegasystems’ solution, BCBS MN is improving reusability across the enterprise and reducing the time, cost and effort involved in achieving claims compliance.

Pegasystems' Claims Repair is pre-packaged business process management (BPM) software containing an extensible library of claim edits, HIPAA 837 claim message handling, and best practice pre-adjudication workflows. The solution automatically receives, enriches and prepares claims so they can be adjudicated by core payer systems thereby improving straight through processing, reducing claims inventories and saving operational expense.

Claims Repair will help BCBS MN meet Blue Cross Blue Shield Association claims mandates that become effective this October. Aimed at increasing provider satisfaction, the BCBSA mandates remove provider claim-filing restraints by requiring accommodation of claim submissions with larger numbers of claim lines, more precise dollar amounts and more specific units of service. By deploying Claims Repair, BCBS MN expects to achieve compliance by the deadline plus also receive additional value through automating their pre-adjudication claim edits.

“As a leading healthcare organization dedicated to customer service, we have taken a strategic approach to the use of technology across our operations,” said Laurie Clark, vice president, Business Design & Enterprise Transactions at BCBS MN. “We have used Pegasystems technology to implement a Common Transaction Framework across multiple areas and now are expanding our relationship by deploying Claims Repair to further automate our claims processing.”

“When we wanted to extend the system to new areas, we did a full analysis and found that Pegasystems’ Claims Repair would give us the quick time to market and functionality we needed to further automate claims servicing,” continued Clark. “Our strategy – and Pega’s software capabilities – positions us well to drive productivity across our claims business andensure outstanding customer satisfaction.”

”With its strategic use of technology to achieve business goals, particularly in the areas of productivity and customer service, BCBS MN is raising the bar for other healthcare organizations,” said Elizabeth Hart, senior director of Healthcare Solutions, Pegasystems. “BCBS MN has set up BPM best-practice groups within their organization, and they have a clear vision for highly effective end-to-end servicing on which they’re executing with impressive results.”

About Blue Cross and Blue Shield of Minnesota

Blue Cross and Blue Shield of Minnesota, with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota’s first health plan and continues to carry out its charter mission today: to promote a wider, more economical and timely availability of health services for the people of Minnesota. A nonprofit, taxable organization, Blue Cross is the largest health plan based in Minnesota, covering 2.9 million members in Minnesota and nationally through its health plans or plans administered by its affiliated companies. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago. Go to www.bluecrossmn.com to learn more about Blue Cross and Blue Shield of Minnesota.

About Pegasystems

Pegasystems (NASDAQ: PEGA), the leader in Business Process Management, provides software to drive revenue growth, productivity and agility for the world's most sophisticated organizations. Customers use our award-winning SmartBPM ® suite to improve customer service, reach new markets and boost operational effectiveness.

Our patented SmartBPM technology makes enterprise applications easy to build and change by directly capturing business objectives and eliminating manual programming. SmartBPM unifies business rules and processes into composite applications that leverage existing systems -- empowering businesspeople and IT staff to Build for Change ®, deliver value quickly and outperform their competitors.

Pegasystems’ suite is complemented by best-practice frameworks designed for leaders in financial services, insurance, healthcare, government, life sciences, communications, manufacturing and other industries.

Headquartered in Cambridge, MA, Pegasystems has offices in North America, Europe and Asia. Visit us at www.pega.com.

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