This Blue Cross plan was seeking to enhance its medical record retrieval and coding processes in order to ensure precise documentation and ultimately optimize member health outcomes. Like many health plans, the organization was facing challenges that are all too familiar in the industry, including complex and evolving regulations, overwhelmed healthcare providers, and the difficulties associated with locating accurate health histories for new members. These issues, if left unaddressed, can have a significant impact on the quality of care provided and on the overall efficiency of the health plan’s operations.

The solution? A strategic partnership with Episource. Together, we took a collaborative approach to understand the unique challenges facing the plan. By delving deeply into the specifics of the issues, we were able to design and implement tailored solutions that targeted the root causes. Whether it was improving coding accuracy, streamlining processes for retrieving medical records, or addressing the challenges of managing a growing and diverse member population, our partnership delivered measurable results. The health plan was able to make significant improvements, not only in the accuracy of its medical coding but also in its ability to ensure better health outcomes for members, thanks to more reliable and comprehensive data.

To learn more about how this Blue Cross plan was able to strengthen its risk adjustment program and how these improvements have translated into better care for members, read the full case study. The detailed explanation outlines the key strategies that were implemented and the successful outcomes achieved.

Additionally, Blue Cross and Blue Shield plans that have partnered with Episource have seen remarkable improvements in coding quality. To discover how these partnerships have helped optimize health plan performance, download our informative infographic for a visual summary of the benefits.