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Cutting Admin Costs by 25% with Healthcare Bluebook and Mphasis Javelina®

THE CLIENT

 

A leading employer-focused health plan administrator.


BUSINESS CHALLENGE

The client needed to strengthen its value-based benefit strategy by integrating Healthcare Bluebook’s provider cost and quality insights directly into its claims operations. The existing setup created several friction points:

  • No automated tie-in between Bluebook scores and claims. Copays had to be manually configured or retrofitted.
  • Limited ability to support variable copays based on provider tiers (green, yellow, red).
  • Fragmented member experience as the transparency tools were separate from claims adjudication.
  • Difficulty scaling varied employer plan designs using Bluebook.

    • This resulted in higher administrative work, inconsistent steerage outcomes, and missed opportunities for savings.

THE SOLUTION

 

Mphasis helped the client integrate the Healthcare Bluebook into the Mphasis Javelina® claims administration ecosystem. The integration enabled real-time mapping of provider cost/quality tiers into adjudication logic. Key components of the solution included:


  • API-based integration bringing Bluebook provider tier data into Javelina.
  • Dynamic copay determination during adjudication using NPI-driven tier logic.
  • Automated steerage & incentive workflows, removing manual interventions.
  • Unified rules engine allowing tier-based benefits without maintaining separate plan versions.
  • Member experience improvement by connecting transparency, incentives, and claims in one platform.

    • The approach ensured accuracy, scalability, and consistent processing across all employer groups.

BUSINESS BENEFITS

25%+ reduction in administrative overhead from eliminating manual copay adjustments and incentive processing.

10-20% increase in high-value provider utilization driven by automated steerage.

30% reduction in benefit configuration updates, as tiers dynamically flow into adjudication.

Improved member experience, with predictable incentives and real-time transparency alignment.

Lower employer medical spends due to increased usage of cost-efficient facilities.

Scalable framework enabling the TPA to rapidly launch new value-based programs across its clients.