The mobility of members and coverage of multi-state groups continually increase the need for the coordination and communication between the local Blue Cross Blue Shield companies. This need for synchronization has prompted the BCBS Association to mandate coordinated system changes for the federation of Blue Cross Blue Shield companies so they remain competitive and expand their national coverage.
Caribou Systems has extensive business and technical experience with the following BCBS Association systems and associated mandated updates:
ITS (Inter-Plan Teleprocessing Services)
The ITS system allows subscribers from any BCBS plan to obtain another BCBS plan’s provider discounts if they use a participating provider’s service while visiting the other plan’s state or region. The effect is a nationwide BCBS Provider Network (OOA).
BlueCard is a collection of policies and provisions, supported by ITS and the Central Financial Agency (CFA), that enable Home Plans to process claims incurred by their members outside of their services area while capturing or taking advantage of the Host Plans discounts.
BlueExchange is an electronic inter-plan clearinghouse for managing the flow of non-standard and HIPAA-compliant transactions between plans. BlueExchange enables plans to communicate through a single standard interface so that each plan does not have to develop customized solutions.
Caribou Systems has worked closely with our Blue Cross Blue Shield partners to review and incorporate these mandated changes. Our consulting services for the initiatives have ranged from supplying a full implementation team to augmenting existing technical and business staff.