Empire BCBS Digitizes EOBs

The beauty of self-service is that it can enhance customer satisfaction as it lowers costs. Giving health plan members online access to explanation of benefits (EOB) documents means not having to field requests via a call center.

Generally, when a health plan member visits his or her doctor, an EOB is subsequently generated and sent to the member's address. Unfortunately, one copy is not always enough. The result for New York-based Empire Blue Cross and Blue Shield ($2.2 billion in assets) was that requests for EOBs became one of the most common reasons for members to access its call center. "Members have lost EOBs, or need an extra copy to coordinate benefits with another carrier," says Stephen Bell, vice president, e-business operations, Empire.

EOB Labor Drain

Unlike some more common requests to the call center, EOB requests not only occupy call center representatives' time, but set in motion a labor-intensive process, including internal request routing, physical storage and mail handling.

In the spring of 2000, as Empire approached the launch of its Internet member portal, the carrier was exploring ways of presenting EOB copies to members via the Web. "Our strategic direction for the portal was very much service oriented, and we wanted self-service transactions for members," Bell says. As a technology partner, Xerox (Stamford, CT) sat in on strategic planning meetings. "Xerox became well-versed in our Web initiatives and approached us with a potential solution."

In July 2000, Empire signed a contract for Xerox's DocumentXchange document access solution, which taps into document print streams to digitize documents for viewing, printing and interactive purposes, such as form completion. Empire's implementation began in October 2000, and focused on document presentation and print-on-demand capabilities. "In November we got it cranking in our test environment as we pulled the whole portal together, and we went live on Dec. 18, 2000," Bell says.

Members securely logging onto the portal can click on an icon reading "View the EOB," which will trigger the opening of the appropriate EOB in PDF format. "In about six seconds the EOB pops up on the screen," Bell says.

Under Empire's existing relationship, Xerox hosts the firm's print and mail operations at the carrier's Albany, NY, location. The solution takes the print stream that is fed into the Albany facility and re-purposes it to the DocumentXchange archive. Software is hosted on two Unisys (Blue Bell, PA) 5085R NT Webservers running in a cluster, with Sun Microsystems (Palo Alto, CA) Magnetic Raid Storage for EOBs from the past two years, and Hewlett-Packard (Palo Alto, CA) Optical CD Juke box for EOBs over two years old. Retrieval time is three to five seconds from magnetic storage, and 15-20 seconds more for optical.

Since implementation, the solution has run very well, according to Bell. "The agreed service level is six seconds or less, and that has been hit very regularly," he says. "With a new technology integrated into the overall Empire architecture you expect some blips, but it's been running very smoothly."

DocumentXchange also improves the traditional call center channel, Bell says. In the past, Empire's reps had to cope with the difficulty of seeing an image of the EOB different from members' printed copies. Now a common image is circulated both internally and externally.

Saving Paper

Bell anticipates increasing member use of the self-service EOB function, resulting in significant reduction of administrative costs. "Every transaction that we can self-service takes a transaction off our call center load," he says.

Empire has begun digitizing other documents and sees the Xerox technology as an important element in an increasingly paperless relationship with members and plan sponsors. Bell says that he expects Empire eventually to be able to work completely electronically with small employer groups and direct-pay customers. "This really gives us the ability to make that a reality, and it's becoming a very difficult prioritization process to say, 'What do we want to do next?'"

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Case Study Closeup

COMPANY

Empire Blue Cross and Blue Shield, New York ($2.2 billion in assets).

LINES OF BUSINESS

HMO, EPO, PPO, indemnity healthcare plans.

VENDOR/TECHNOLOGY

Xerox (Stamford, CT) DocumentXchange; Unisys (Blue Bell, PA) Webservers; Sun Microsystems (Palo Alto, CA) Magnetic Storage.

THE CHALLENGE

Handle EOB requests via online self-service.

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio