In highly regulated markets such as healthcare and insurance, the ability to quickly react to new legislation as well as changes in state or federal regulations remains a top priority. Cigna (NYSE: CI) is a global health service company with approximately $35 billion in annual revenue focused on helping people improve their health, well-being and sense of security. Cigna is dedicated not only to meeting stringent and evolving policies and mandates, but doing what it can to get ahead of them.
Since 2011, Cigna has relied on Progress® Corticon® Business Rules Management System (BRMS) to automate the business decision process within its holistic enterprise claim intake system. As with all health insurance companies operating within the U.S, Cigna receives and processes Electronic Data Interchange (EDI) 837 healthcare claims. This format was established to meet the Health Insurance Portability and Accountability Act (HIPAA) requirements for the standardized electronic submission of healthcare claim information, such as a patient description, the patient’s condition for which treatment was provided, the services provided and cost of the treatment.
“It was a complex project,” said Allison Greco, Application Development, Senior Director for Cigna.
Cigna chose Corticon to enable automated and integrated business decision support. By separating the business rules from the underlying application code, Corticon provides Cigna with the agility to better develop, test and deploy new rules or modify existing rules.
“We chose Progress Corticon based on its ease of use, such as its drag-and-drop functionality, as well as the intuitive Business Rules Studio that allows us to model and deploy business rules without the need for traditional programming,” explained Ernie Looney, Application Development, Senior Specialist for Cigna.
Using Corticon, Cigna’s new claim intake system leverages automated business rules to determine a customer’s eligibility for payment based on factors such as coverage, medical procedure and who submitted the claim, among others. It then determines which claims management system the claim should be routed to for processing. “The goals for us from a customer and business perspective were to ensure accuracy, timeliness of processing and ease of maintaining and support,” said Greco.
The ability to centralize Cigna’s rules-based processing has improved both the efficiency and accuracy of the claims routing process, while reducing maintenance.
Cigna (NYSE: CI) is a global health service company dedicated to helping people improve their health, well- being and sense of security. All products and services are provided exclusively through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy and vision care benefits, and other related products including group disability, life, and accident coverage. Cigna has sales capability in 30 countries and jurisdictions, with approximately 86 million customer relationships throughout the world. www.cigna.com