IBM makes move into health care market

Computerworld - Empire Blue Cross and Blue Shield and IBM have entered into a 10-year technical agreement to develop an automated claims reading and processing service, IBM announced today.
IBM said the service will use software from Lexington, Mass.-based deNovis Inc. running on an IBM e-business infrastructure.
Empire spokeswoman Deborah Loeb Bohren said the agreement allows English-language business rules, regulations and benefits to be read by the machines, which will speed up claims processing. New York-based Empire Blue Cross and Blue Shield, also known as Empire HealthChoice Inc., has 4.7 million subscribers.
The software contains more than 20,000 fields that cover contracts, regulations, benefit packages and business rules, deNovis Chief Technology Officer John Trustman said. This allows the program to find the contracts, agreements and regulations that pertain to a transaction and give the user the correct results on the first pass.
Bohren said hundreds of thousands of processing rules are involved in these transactions. Empire has been working to streamline Web-based transactions for doctors and patients for the past two years. Today's package is for the back end of the health insurer's operation and will allow for customized benefit plans and enhanced customer service systems.
Empire will be able to retire 22 million lines of legacy code, according to a statement by Bohren.
Trustman said the software is built on an open-systems environment that runs on high-end IBM machines and is "100% pure Java."
IBM vice president Doug Williams said his company is porting the software onto its Z-series mainframes.
"We wanted to make sure the software is scalable for the largest health care systems in the country," he said.
While the package might have other uses, IBM for the time being is focusing its efforts on health care, Williams said. The idea is to create a way for the health care industry to cut paperwork and administrative costs so it can funnel money back into clinical operations.
Under the terms of the agreement, about 360 Empire employees will be eligible for positions at IBM. Bohren stressed that the processing of transactions will be under Empire's control and won't be outsourced.

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