CGI leverages expertise in healthcare regulatory issues

"HIPAA will have a profound impact on our business, both from a technology and operational standpoint. We chose CGI because of its national reputation on healthcare regulatory issues and its high-end technology capabilities."

John Proctor, Vice-President Corporate Affairs, BlueCross BlueShield Mississippi

For more than a decade, CGI has provided a broad spectrum of healthcare consulting services focusing on regulatory compliance in the payer and provider markets. BlueCross BlueShield engaged CGI's expertise in its efforts to comply with the U.S. Health Insurance Portability and Accountability Act (HIPAA).

The Challenge
BlueCross BlueShield of Mississippi, a for-profit mutual insurance company, offers its clients the largest network of doctors, hospitals, and other healthcare providers available in the state. With more than 1,000 employees, advanced technology, and a strong commitment to excellent service, the company processes approximately 10 million healthcare claims and pays out more than $1 billion in medical expenses each year.

Under the HIPAA, the U.S. Secretary of Health and Human Services is authorized to promulgate regulations necessary to achieve several goals of administrative simplification within the healthcare industry. The goals include developing electronic standards for healthcare transactions, ensuring the security of healthcare data and systems, and protecting the privacy of personal health information. In light of these developments, BlueCross BlueShield recognized the need for assistance to achieve its goals of regulatory compliance, understanding and interpreting HIPAA regulations, and educating the entire organization on HIPAA and its impact. CGI's noted expertise in healthcare consulting coupled with its understanding of the new HIPAA regulation and its effect on healthcare organizations, was precisely the medicine the insurer was looking for.

The Strategy
CGI's mandate was to conduct a HIPAA impact assessment and gap analysis that would take into account the insurer's applications, systems, vendors, and partners. Prior to the assessment, CGI developed and conducted multiple educational programs for company executives and senior management. CGI put together an impressive consulting team that included experts in claims processing, transaction and codes sets, national identifiers, security, privacy, and technical training. In their analysis, the team would examine the cost of resources, opportunities, risks, and other significant budgetary impacts.

The Technology

• Consulting assignment

The Results
CGI conducted a gap analysis and developed an impact report for the business areas of the company. Business areas examined included claims (medical, pharmacy); corporate accounts administration, including re-insurance, membership, and billing; customer service; marketing, underwriting; utilization management (case management), provider contracting; provider credentialing; security administration policies and procedures and infrastructure components and compliance. A similar gap analysis was provided for the company's hardware and software components and for third-party interfaces.

With CGI's HIPAA knowledge and its compliance experience, BlueCross BlueShield now has a complete and detailed assessment of the risk areas and impact that the HIPAA transaction and code set regulations will have on its business. The assessment took into account the company's corporate strategy and e-business plans. Moreover, CGI's organization-specific training provided the information necessary to use the detailed analysis and recommendations to develop a strategic remediation plan to gain HIPAA compliance. And in the process, BlueCross BlueShield was able to benefit from the required knowledge and expertise without adding staff or removing staff away from mission-critical work. Said John Proctor, Vice-President of Corporate Affairs at BlueCross BlueShield, "HIPAA will have a profound impact on our business, both from a technology and operational standpoint. We chose CGI because of its national reputation on healthcare regulatory issues and its high-end technology capabilities."