CASE STUDY

BLUE CROSS AND BLUE

SHIELD OF LOUISIANA:
Growth, flexibility and efficiency with
TriZetto technology-enabled solutions

The Client
Louisianas oldest and largest domestic health insurer, Blue Cross and Blue Shield of Louisiana
(BCBS of La.) marked its 75th anniversary in 2009. BCBS of La. currently serves nearly 1.4 million
members with a full line of health insurance products for individuals and groups.
In 2012, BCBS of La. received the TriZetto IHM Power Award for Operational Excellence, in
recognition of the companys pursuit of Integrated Healthcare Management (IHM), an advanced
business model.

The Challenge
Until 2005, BCBS of La. had used an internally developed mainframe COBOL system for core
administrative functions, including claim processing, membership/enrollment, and provider and
call-center support. The legacy system had been developed in the 1970s, and maintenance costs
were becoming an issue.
We knew the massive amount of effort, cost and inefficiency we dealt with in previous remediations
of the legacy system to address industry changes would not be productive or cost-effective moving
forward, says Samuel Griffin, Vice President in Benefits Administration at BCBS of La.
In addition, the skill sets and resources needed to maintain the system were no longer readily
available. When the Blue Cross and Blue Shield Association instituted the BlueCard ITS program
for coverage of members traveling away from home within the United StatesBCBS of La. faced
additional programming demands.
Finally, from a high-level viewpoint, our ability to address change in the marketplace in a flexible
and nimble manner was becoming an important factor in our future product strategies, Griffin
says.
Migrating to a new core system is a once-in-a-generation process for our organization, since we
were operating on a legacy system developed over 30 years ago, he says. It was crucial that we
choose the right systema system that we knew we could grow with, and that would allow us to
meet our goals of being flexible and nimble in the marketplace.

The Solution
After extensive research, BCBS of La. selected the TriZetto FacetsTM core administrative system,
which helps payers respond quickly to new opportunities, maximize efficiencies through greater
automation, and enable seamless transactions among providers, members and the payer. The
Facets ITS Home and Host Interfaces, also chosen by BCBS of La., enable seamless transmission
of claims from one Blue Cross and Blue Shield plan to another, a necessity under the BlueCard
program.
BCBS of LA also elected to implement the TriZetto NetworX Pricer and NetworX Modeler
applications, which automate provider-contract modeling, claims pricing and network
administration.

THE CLIENT
A Blue Cross and Blue Shield
organization serving nearly 1.4 million
members.

THE CHALLENGE

Replace a 1970s-era legacy system

with an advanced core administrative
system that would support growth,
flexibility and efficiency.

THE SOLUTION
The TriZetto Facets core
administrative system; TriZetto
NetworX Pricer and NetworX
Modeler applications; TriZetto
Facets ITS Home and Host Interfaces;
and TriZetto Advantage Services
(implementation, training).

THE RESULT
The organization has:
Reduced by 75 percent the time
required to complete product/
benefit configuration.
Increased the first-pass rate for
claims to 85 percent, up from
66 percent the first year after
implementation.
Streamlined the creation of provider
networks and agreements, which
are now maintained by the business
staff, as opposed to the IT staff.

TriZetto Advantage ServicesTM professionals played key roles in the implementation projects. With three
unique categories of servicesApplication Management Services, Business Management Services, and
Consulting ServicesTriZetto Advantage Services help more than 120 clients every year implement,
manage and leverage technology.
BCBS of La. began the migration to the new system in 2005.

Result
The move to the Facets system has been extremely successful, Griffin says. We now have our entire
book of business for the company running on Facets. Approximately 1.4 million members are being
supported and serviced utilizing the Facets platform. The migration occurred without business
disruption, he adds.
Since the implementation, BCBS of La. has reduced by 75 percent the time required to complete
product/benefit configuration. The companys first-pass rate for claims has increased to 85 percent, up
from 66 percent the first year after the implementation. Recently, BCBS of La. configured, enrolled and
processed transactions for a 155,000-member self-funded group in a matter of weeksrather than
monthsusing configuration options available in the Facets system.
In the initial phases of healthcare reform, we were able to address the changes needed in our product
portfolio in a few weeks utilizing Facets configuration options, Griffin says.
The NetworX Pricer application has enabled fast, efficient creation of provider networks and
agreements, which are now maintained by the business staff, not the IT staff. The ITS modules have
delivered key benefits as well, Griffin says. TriZetto has done a great job, in our opinion, of meeting
the requirements of the Blue Cross and Blue Shield Association within the ITS modules. With the ITS
modules, we have not missed a BlueCard ITS system mandate since we went to Facets.
During the system implementation, TriZetto Advantage Services consultants were instrumental in
assisting us with high-level knowledge of how to construct benefit design and understand the product
suite, he says. We engaged TriZetto Advantage Services on configuration training, so we had trainers
on site for a couple of weeks, going through the basics of how to do the configuration. We also engaged
TriZetto technical resources for data-model training a couple of times.
Our IT department has also engaged TriZetto Advantage Services to assist with performance and
capacity monitoring and assistance. And Services has supported us in the building and integration of a
new book of business, Griffin says.

The migration of our business to Facets has been extremely successful,

without any business disruption during the process. The Facets system, along
with the supporting modules we utilized, greatly enhanced the ability to
succeed in the migration.
Samuel Griffin, Vice President in Benefits Administration, Blue Cross and Blue Shield of Louisiana

About TriZetto
TriZetto, a Cognizant company and business unit within Cognizants healthcare practice, provides
world-class information technology solutions to make better healthcare happen. TriZettos world-class
technology products, in combination with Cognizants consulting, IT and business process services at
scale dramatically simplifies the deployment and adoption of technology and improves operations
helping to reengineer the business of healthcare today, while reimagining it for tomorrow.

For more information on how TriZetto can help you enhance revenue growth,
drive administrative efficiency, and improve the cost and quality of care, call
1-800-569-1222 or visit www.trizetto.com.

TriZetto Corporation
Corporate Office
9655 Maroon Circle
Englewood, CO 80112
1-800-569-1222
www.trizetto.com

Copyright 20153 TriZetto Corporation. All rights reserved. TriZetto, the TriZetto Triangle logo, NetworX Pricer and NetworX Modeler are registered trademarks, and Facets and TriZetto Advantage
Services are trademarks of TriZetto Corporation, or its subsidiaries. Other company and product names may be trademarks of the respective companies with which they are associated. The mention of
such companies and product names is with due recognition and without intent to misappropriate such names or marks.

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