Provider Data Assessment for Blue Cross NC

This document is a case study detailing the provider data assessment conducted by Mediant Health Resources for Blue Cross and Blue Shield of North Carolina (Blue Cross NC). The assessment was initiated to evaluate and enhance the scalability and effectiveness of Blue Cross NC's provider data management systems. The project began after Blue Cross NC faced challenges with a third-party vendor error that led to significant billing issues. Mediant's assessment revealed inefficiencies in the existing system architecture and highlighted the need for a data quality process. The deliverables from this engagement included an in-depth provider data audit, a detailed process assessment, and a provider data roadmap known as the 'Provider Manifesto'. The project was completed ahead of schedule, allowing Blue Cross NC to move forward confidently with their implementation of the TriZetto® Facets® core administration platform. Mediant's expertise and timely delivery were critical in addressing the data anomalies and ensuring effective claims processing.