Solutions for commercial healthcare payers

Healthcare payers are challenged to hold down costs while meeting demands for high quality care. CGI understands these challenges. We have worked with BlueCross BlueShield plans, managed care organizations, commercial health insurance companies, state Medicaid agencies and the Medicare program to deliver solutions that lower costs and enhance productivity while helping to focus on what matters most—providing high quality care.

From proprietary software to consulting, application and outsourcing services, our seasoned team of reimbursement, clinical, financial, IT and coding experts customizes our solutions to meet your requirements. CGI helps payers achieve the following benefits:

• Control costs
• Solve complex challenges
• Maintain compliance
• Ensure the integrity and accuracy of medical and pharmacy claims
• Prevent claims overpayments
• Recover overpaid claims due to billing errors
• Make appropriate reimbursements
• Protect provider relationships
• Detect and investigate fraudulent claims

Solutions to reduce medical costs for healthcare payers

Customized Audit System (CAS 5.0) (PDF) – An enterprise-wide solution that helps you efficiently predict, identify, manage and analyze your medical and pharmacy claims.

• Edits (PDF)
• Enterprise Content Management (PDF)
• Pharmacy Claims Auditing (PDF)
• Predictive Analytics (PDF)
• Medicare Advantage Risk Adjustment Audit and Analysis (PDF)

Reimbursement Consulting – Comprehensive payment methodology consulting and proprietary software to manage inpatient, outpatient and professionals' reimbursements

• Download the APC Assessment and Implementation and hospital Inpatient Claims Pricing Engine brochures (PDFs)

Software and services

• Clinical Audit and Compliance Services
• Medical Audit and Recovery Services (PDF)
• Medicare Business Process Services (PDF)
• National Provider Identifier (NPI) Services (PDF)
• Fraud and Abuse Prevention Services (PDF)
• CAS-Rx (PDF)
• ECM for Healthcare Payers (PDF)
• Special Investigative Unit (SIU) Services

–	Brochure - SIU for Healthcare (PDF)
–	White paper - Challenges in fighting insurance fraud and the value of Special Investigative Unit outsourcing (PDF)

Also see

• Brochure - Business and IT Solutions for Healthcare Payers (PDF)
• Brochure - Prescription Claims Analysis Services for Part D (PDF)
• Solution - Finanacial and Organizational Consulting for Healthcare Payers
• Events - January 24-25, 2008, Medicare Advantage Congress, Scottsdale, AZ
• Events - May 18-21, 2008, BCBS National Internal Audit & Anti-Fraud Conference, Scottsdale, AZ
• Events - June 18-20, 2008, AHIP's Institute: AHIP's Annual Meeting, San Francisco, CA

For more information about CGI's solutions for commercial healthcare payers, please contact us at healthcare.bps.hgov@cgi.com.