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Business Process Solutions

Business Process Solutions help Plans identify cost-savings and cost-avoidance opportunities, and NASCO delivers these through ongoing process efficiencies to BCBS Plans. By offering business process services, NASCO is able to add greater business value and respond to the complex needs and challenges facing BCBS Plans today. NASCO’s goals in offering BPS are to provide services that lower operational costs while improving quality and to ensure that all Plans can respond to and adapt to market changes, mandates and regulations more effectively, regardless of Plan size or location.

Initially, NASCO will focus on improvements to the back office by providing solutions that provide business value in operational areas such as claims processing, service operations, and enrollment and billing. Eventually the BPS offering will address front and middle office functions and be available to all BCBS companies, not just those using the NASCO platform.

CLAIMS PROCESSING

Claims Processing

For Claims Processing, NASCO will assess a Plan’s back-office activities, ranging from mailroom processes to getting checks out the door.

Areas include: Claim Entry, Claim Adjudication, Overpayment Identification, Adjustments and Appeals.

SERVICE OPERATIONS

Service Operations

For Service Operations, NASCO will assess current call center procedures and identify steps to more efficient operations.

Areas include: Provider Call Centers, Member Call Centers and Member Grievance.

ENROLLMENT & BILLING

Enrollment & Billing

For Enrollment and Billing, NASCO will assess the member and group enrollment and maintenance processes, member outreach activities, and premium billing payments and reconciliation processes.

Areas include: Member/Group Entry and Maintenance, Member Outreach, and Premium Billing and Reconciliation.