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.