HealthNow New York Inc. Empowers Business Users to Drive Improvements in Claims Processing and Increase Member Retention and Loyalty

HealthNow New York is using Pegasystems (NASDAQ:PEGA) to optimize its claims management process and hold down premium rate increases. By upgrading to Pegasystems’ latest Build for Change^® technology, the leading New York health insurer will enable their business users to capture and drive business improvement ideas and goals quickly and more effectively.

This new initiative for HealthNow drastically reduces the lag time between business intent and solution delivery. HealthNow is now able to enhance the speed and responsiveness of new productivity improvement ideas, ensuring quicker benefits to end users, including members, physicians and regulators. The deployment of Pegasystems’ latest Build for Change technology across three claims related applications is expected to take less than five months, and is intended to improve service delivery, decrease administrative costs and minimize manual coding.

"HealthNow is focused on delivering the highest quality products and services to our members. We also want to simplify processes for our employees. Pegasystems has been a trusted partner of ours in these efforts,” said Paul Stoddard, vice president and chief information officer at HealthNow. "The deployment of the Pegasystems’ healthcare solution frameworks for claims repair and management will allow us to accelerate innovation, drive greater productivity and ensure that our customers receive outstanding service.”

"HealthNow continues to show exemplary commitment to its customers by enhancing its services through advanced and innovative use of technology,” said Elizabeth Hart, senior director of Healthcare Solutions at Pegasystems. "The new initiatives at HealthNow will provide a stronger platform to further streamline their claims processing operations and achieve new levels of business success and customer satisfaction.”

HealthNow is utilizing multiple Pegasystems’ healthcare solution frameworks to jumpstart these initiatives. Pegasystems BPM solution frameworks are pre-configured to industry specific best practices, and enable users to quickly get new BPM solutions up and running to drive business transformation. Pegasystems’ Claims Repair^™ solution framework improves straight through processing, reduces claims inventories and shortens development time for new edits. It also provides pre-packaged best practice claim edits for improving auto-adjudication of claims. The system receives targeted claims utilizing HIPAA compliant claims message handling, then researches, corrects and submits them for finalization.

The second new BPM solution framework being used by HealthNow, Pegasystems’ Claims Workstation+^™, drives dynamic claims management, eliminates claims backlogs and improves operator productivity. It prioritizes, escalates and routes pended claims to operators for finalization, optimizing work distribution and skill matching for intelligent claims inventory management.

About HealthNow New York

HealthNow New York Inc., headquartered in Buffalo, New York with annual revenues exceeding $2 billion, is one of the leading healthcare companies in Upstate New York. Through its divisions, HealthNow provides access to quality health care and innovative wellness solutions for more than 815,000 members. It is the parent company of BlueCross BlueShield of Western New York, BlueShield of Northeastern New York, HealthNow (in Central New York), MedUS LLC in Binghamton, NY, and Brokerage Concepts, Inc. in King of Prussia, PA.

About Pegasystems

Pegasystems, the leader in Business Process Management, provides software to drive revenue growth, productivity and agility for the world's most sophisticated organizations. Customers use our award-winning SmartBPM^® suite to improve customer service, reach new markets and boost operational effectiveness.

Our patented SmartBPM technology makes enterprise applications easy to build and change by directly capturing business objectives and eliminating manual programming. SmartBPM unifies business rules and processes into composite applications that leverage existing systems -- empowering businesspeople and IT staff to Build for Change, deliver value quickly and outperform their competitors.

Pegasystems’ suite is complemented by best-practice frameworks designed for leaders in financial services, insurance, healthcare, government, life sciences, communications, manufacturing and other industries.

Headquartered in Cambridge, MA, Pegasystems has offices in North America, Europe and Asia. Visit us at www.pega.com.

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