Cloud Based Platform for Healthcare Billing and Reporting

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Business Problem

The Client is a renowned player in offering pharmacy services. Their customers who were independent pharmacies and clinicians were struggling with bill submission for clinical services rendered in addition to the complex regulations. A bespoke solution would simplify the billing process and create new revenue streams.
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Solution

A cloud-based analytics driven platform for quick & efficient, on-the-go healthcare claim submissions and eligibility checks that provides precise insights and analytics on claims. Provides the pharmacists and clinicians with online submission ability to all payers nationally.

How did we do it?

  • Prototyped and developed user-interface for cloud-based platform
  • Developed data architecture and web services for interacting with UI
  • Integrated with third-party APIs for seamless claims submissions and eligibility checks
  • Developed insight reports for visualizing claims & billing analytics
End-to-End Mediclaim Processing Automation Platform on Cloud
Pharmacy using the platform submits a claim to the Clearing House
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The Platform receives rejected claims and suggests pharmacists on required corrections
Clearing House does Data Validation and forwards it to the Insurance Company for review
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The Clearing House, while “scrubbing” for accuracy, sends back claims needing correction to the pharmacy
The Insurance Company approves the claim
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The Insurance Company when requiring more information, sends the claim back to the clearing house & pharmacy
Remittance processed
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The Platform

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Check Eligibility

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Manage Patients

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Manage Claims

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View Reports

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Admin

Key Features

Eligibility Checks | Patient Records | HIPAA Form | Diagnosis Coding | CPT Coding Accounts Receivables | Customizable Links

Business Outcome

Time & Cost

  • Reduced time taken for medical billing
  • Data quality management resulting in nearly no rejections
  • Low-cost, high-efficiency solution for smallscale and independent healthcare providers

Quality

  • Maximize patient facing time by reducing time spent by practitioners on paperwork
  • Real-time update of patient and provider information
  • Easy access via laptop and mobile devices

New Revenue Streams

  • Injections
  • Vaccinations
  • Wellness Checks
  • Health Screens
  • Monitoring
  • Consults- MTM
  • Skin Disorders
  • Minor Illness
  • Minor Injuries