Cloud Based Platform for Healthcare Billing and Reporting
Industry
Healthcare
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.
Solution
Data Management & Governance, Architecture & Design, Business Intelligence
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
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
The Clearing House, while “scrubbing” for accuracy, sends back claims needing correction to the pharmacy
The Insurance Company approves the claim
The Insurance Company when requiring more information, sends the claim back to the clearing house & pharmacy
Remittance processed
The Platform
Check Eligibility
Manage Patients
Manage Claims
View Reports
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.
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