Understanding Problems to Lead Change
Medical claim denials and rejections are one of the huge obstacles affecting healthcare reimbursements.
Few small coding errors can prove very costly and may have a significant, negative impact on your overall revenue cycle.
Checking the claim status in every phase of the claim processing life cycle is a lengthy process that consumes a significant amount of time and human resources.
The collected claim status data should be readily accessible and easy-to-understand. This data should comply with HIPAA requirements that protect patient privacy and prevent frauds.
A healthcare-based US firm wanted a better and agile solution to get medical claim status for faster reimbursements and efficient analysis. They wanted to replace manual paper-based claim data management system to a single and shared interface for automated claim tracking. OSP offered a web-based application to manage patient's claim information in real-time, while maintaining the HIPAA compliance backed by AWS cloud hosting.
Creative Viewpoints For Right Direction
The proposed web application needed to quicken the manual process of claim processing by simplifying the claim status inquiry through digital automation.
Our client's emphasis was on the accuracy, speed, and optimization of the entire claim processing flow.
The medical claims, catered by our client, were of high dollar amounts and involved a complex medical coding with better accuracy.
OSP started gathering the resources to streamline the process of claim data collection and its intuitive visualization.
OSP started working on defining the scope of the proposed custom claims data management solution by analyzing every aspect of the project. OSP' teams have undergone a feasibility analysis to evaluate the qualitative project management in the cloud. The gathered claims data was required to be shared among multiple users with different level of accessibility. At OSP, we focused on creating a shared user management console with easily accessible claims documents and other data. We have worked on exploring the necessary government regulations and compliances to securely handle patient's claims data.
Defining the Solid Roadmap
ted gathering the resources to streamline the process of claim data collection and its intuitive visualization.
The goal is to determine precise details concerning the analysis of the project life cycle and develop a detailed timeline outlining the development and delivery of the project.
We estimated the need of separate dashboards for system admin, doctors, and employee to access the claims data with pre-defined accessibility.
We decided our technology stack based on the project requirement and the current market trends.
Through our analysis phase, we have decided to put more emphasis on HIPAA-compliance and other necessary regulations to maintain the data security.
Before proceeding to the development of the claim's data management solution, we focused on creating a three-tier system architecture with multiple milestones for each prototype. It was designed in such as way that every milestone delivery required sign-off from your end to begin new milestone. To make project comprehensive and user-friendly we decided to maintain the following compliances,
Delivering On the Promise
We created an automated solution for self-service claim inquiry and follow up on rejected claims. Cloud-based web application for the
Our cloud-centric custom claims data management software solution allows uploading 'Claim Follow up Report' and manage claims data in an assorted manner.
We brilliantly enlisted reminder algorithm to alert doctors of their respective claims and expected actions.
Our agile development methods and latest technology stack enabled the advanced database management to manage all the obtained doctor feedbacks and PHI data in a secure manner.
We managed to build a tailored claims management solution to allow clients to manage information of the claims, update their status and send notifications to clients for pending documents/feedback for claims. OSP's advanced system will also send automated reminders to check and update the documents/status of the claim before the end date. Our system can also act as an automated tool where the clients can see the status of claims and get alerts about the updated notes. We have followed HIPAA & PCI compliance standards backed by AWS cloud hosting to maintain necessary government compliance.
Building to Deliver Experiences
Our tailored claims data management solution was delivered for the initial infrastructure, according to plan within two weeks, and developed the complete system within four weeks.
We adopted agile methodology and design-led approach to simplify the major hurdles we faced during the development phase.
We followed an exhaustive testing routine throughout the development process to ensure the excellent functionality of the built solution.
Our made-to-order claims data management solutions are scalable and can be customized sp per the latest requirements of doctors, hospitals and FQHCs.
The traditional claim data management system was completely manual, time-consuming and required human efforts. OSP's made-to-order claims data management software solution helped to quicker claim processing with a notable reduction in claim errors. We helped the client to reduce the overall cost needed for claim status verification. Our cloud-driven claim data management solution plays a vital role in reducing claim denials with inbound claims analysis. The client can now manage HIPAA-compliant claim data with secure cloud support, keeping all information backed up.
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