Premera’s Calypso business unit saves healthcare payers millions annually by discovering, recovering and preventing insurance overpayments. Their existing business was auditing the claims submitted by 3.8 million insured members each month and comparing them with claims submitted during the past 24 months. Demand from new customers was strong.

Their challenge came down to a simple question – “How can we add new customers quickly and cost-effectively without increasing auditor headcount?” While the current overpayment discovery approach produced results, it was inefficient and largely ad hoc – providing auditor teams with minimal support for prioritizing investigations and often resulting in duplicate work.

It was time to drill into the details – and that’s precisely what Calypso hired us to do. Together, we dug into, and re-designed core operational processes and systems for claims overpayment discovery and prevention. We analyzed thousands of claims to understand how best to prioritize audit efforts and designed algorithms to find miss-payments with much less effort. The resulting solution included new audit procedures and a new claims auditing system.

The new system that enables these results includes essentially no custom code. It utilizes the Microsoft SharePoint composite application platform. The system audits over one million new claims each month and includes an on-line database of over 30 million claims. CEO Catherine Albert says, "It's simple, familiar, low maintenance and evolves with our business."

In production since early 2007, the discovery solution paid for itself within seven months. View video case study on Microsoft.com.