Medicaid Billing Tracking Solution

Retroactive Medicaid coverage is a long-standing protection, built into the program for low-income Medicaid recipients and their healthcare providers.

From the perspective of healthcare providers, the Retroactive Medicaid is a great initiative to maintain the continuity of administered care to those who cannot afford it.

Every day several self-pay encounters, within a provider system, become eligible for retroactive Medicaid reimbursement that are not tracked due to unavailability of a proper system.

Every day many retro-eligible encounters are missed and get expired because they weren’t discovered and billed in time.

Our goal was to create a cloud-powered web application to monitor the reimbursable retroactive Medicaid encounters efficiently and help the healthcare facility users recieve details about un-worked items of the facility.

After brainstorming with the client, OSP proposed a comprehensive system that would bel be connected to the existing Azure database and actual web-application database. The applications users can easily monitor the 'un-worked' items and manage only the status as Billed/Non-Billed.

The applications users can easily monitor the 'un-worked' items and manage only the status as Billed/Non-Billed.

Accessing the client facility's unworked data was the biggest challenge. We smartly integrated the client's existing billing system' Azure database with our web-application database, in order to access the 'unworked' reimbursement data of the client's facility.

We designed the system with an interactive dashboard that can showcase facility name, tracking count and smartly captured count with filter options.

We have worked diligently to create an easy-to-use web-based interface with designated user modules to manage status as Billed/Non-billed.

We ensured automated client ID mapping to associate the sublevel department with specific healthcare providers.

Our custom solution included advanced database management to manage the tracking count, captured and recovered reimbursements with activity tracking and alerts.

OSP’ intelligent solution helped the client to enhance the reimbursement by examining all non-billed encounters for Medicaid eligibility and locate potentially billable encounters.

We adopted a flexibile and client-centric approach in our work methodology to solve the significant challenges during the development phase.

OSP managed to achieve 100% HIPAA compliance for patient data and system access.