MEDICAL DEVICES: CLAIM BILLING SYSTEM

Customer

Our client provides medical products and services for advanced orthopedic patient care. In the past several years, they acquired new companies, which necessitated a new billing solution to their ever-growing, innovative line of business.Due to the nature of the business all products and solution needs to be HIPPA and CFR Part 11 compliant.

Challenge

Our client wanted to build a fully integrated billing solution that was capable of scanning and importing paper claims, submitting documents to the accounts payable system, and finally collect payments or report bad dept. The key objective was to reduce the amount of time it takes to collect claim data and get paid quickly and in a timely manner. Another objetive was to reduce bad debt due to inacurate informaiton collected on claims.

Solution

BI Demantra created a fully integrated custom SharePoint and .NET solution to meet customer’s requirements. The new solution allowed employees to capture scanned data in XML format and saved a considerable amount of time in data entry.

 

The solution also integrated in real-time with Oracle for invoicing, Brightree for payments, and Microsoft Reporting Services and Power BI for reporting. Additionally, the master data such as diagnostic codes and Payers was managed using Master Data Services within SQL Server.

 

 

Result
  1. Using Microsoft platform enabled our client to leverage their existing investment in SharePoint and SQL Server.
  2. The new solution implemented by BI Demantra also reduced the time it took to submit a claim. It also minimized bad debt due to slow and inaccurate claims processing.
  3. The new solution also created a fully automated process with minimal touch points. It enabled our client to process thousands of claims per month. it was scaled to handle more than 200K claims per month.