Health insurance plans
Skyrocketing healthcare costs and healthcare reform are radically changing how health insurance carriers do business, forcing them to rethink their business strategies and operations. Carriers are challenged to deliver better coverage for less cost, while complying with new and evolving government mandates, such as electronic health records, health insurance exchanges and electronic healthcare transaction standards.
CGI's health insurance plan services and solutions help carriers navigate the fast-changing healthcare landscape and choose a path toward long-term growth and profitability. Our expertise empowers them to achieve the following:
- Drive efficiencies
- Lower administrative costs
- Offer better products and services
- Improve claims management
- Enhance customer relations
- Improve sales and marketing
- Evolve legacy systems
- Leverage new technologies
- Better connect with providers
- Comply with healthcare reform mandates
CGI's health insurance plan expertise
With 20+ years of experience in the health industry, CGI's health insurance plan expertise spans all three segments of the market—commercial, Medicare and Medicaid. Our services and solutions have benefited more than 6,000 health insurance carriers and more than 45 million beneficiaries. We've worked extensively with commercial health insurance plans, health insurance exchanges, state Medicaid agencies, and the federal Medicaid and Medicare program, transforming their operations and delivering business results.
The depth of our experience has given us a broad understanding of industry trends, requirements and solutions. This combined with our full suite of technology services, including systems integration and consulting, application management and infrastructure management, help to ensure health insurance carriers benefit from the best possible know-how, guidance and technologies
In addition, CGI's rigorous project management approach ensures on-time, on-budget delivery, and through our global delivery model, we offer flexible onshore, nearshore and offshore options.
CGI's health insurance plan services and solutions
CGI offers a comprehensive suite of services and solutions, designed to improve all facets of a health insurance carrier's operations. Our health insurance plan offerings include the following:
- Claims processing. CGI can enhance and manage your claims administration, while freeing you to focus on your core business.
- Claims auditing. Our consulting services and software solutions have helped health insurance plans recover more than $1 billion in lost payments due to improper claims.
- Claims fraud investigation. CGI's anti-fraud software solutions help detect, remedy and prevent fraud. We also offer a special investigative unit made up of experienced law enforcement professionals who provide a range of services to combat fraud.
- Enterprise planning and intelligence. CGI HEROadvisor™(HERO) is a suite of next-generation enterprise planning, decision support and business intelligence solutions for health plans.
- Health insurance exchanges. CGI's Health Insurance Exchange360™ solution enables states to effectively implement and manage health insurance exchanges, and we also provide consulting services for health insurance carriers and government agencies to facilitate their participation in these exchanges.
- Health portals. CGI has developed high-profile healthcare sites and portals for large health insurance plans, as well as government health agencies, such as HHS.gov, Medicare.gov, mymedicare.gov and HealthCare.gov.
- 5010/ICD-10 compliance. CGI designs and implements system and business process changes required to meet new ICD-10 and Version 5010 standards, helping health insurance carriers meet tight compliance deadlines and avoid costly delays in reimbursements.
- Payment reimbursement. Our reimbursement consulting services and proprietary software help health insurance carriers implement effective prospective payment methodologies and processes for both inpatient and outpatient services.
Recovery Audit Services (PDF)
- Advanced Analytics (PDF)
Enterprise planning and intelligence
CGI HEROadvisor™ (PDF)
Health insurance exchanges
- ICD-10 Training and Consulting Services (PDF)