FQHC Dental Claim Management Solutions | FQHC Dental Billing Solutions

Our journey

Kick Off

CHALLENGE

Automate billing workflow to manage dental reimbursements efficiently.

EXPLORATION

Gathering resources to enhance the go-to-market strength.

ANALYSIS

Designing customized system architecture to optimize billing workflow.

SOLUTION

Tailored & HIPAA compliant dental health billing platform in the cloud.

RESULT

Quicker claim reimbursement with seamless provider network management.

Iteration
& Support

Our Journey

CHALLENGE

Understanding Problems to Lead Change

The dental health billing faces a number of emerging financial changes and challenges while achieving and sustaining a stable cash flow.

From a business perspective, there efficient dental billing is one the major tasks that the dentist and their staff must regularly complete to keep with.

The manual paper-based billing process employed by many dental health clinics and FQHCs is completely outdated. The existing dental health service providers are facing huge stress on billing management workflow due to increasing number of patients under the dental health coverage.

The collected health data must be reported accurately and consistently and must comply with HIPAA requirements that protect patient privacy and prevent frauds.

Our client was a healthcare claim management company in California which catered to the needs of dental clinics, FQHCs, private practitioners, nurses, and payer managing the dental patients. The client wanted a custom-made software to replace the paper-based manual claim process.

Our client, the dental healthcare claim management company in California, wanted to replace paper-based claim process with a HIPAA-compliant automated system. A system that can be used across doctors, nurse practitioners, and payers to manage the dental patient. Our client wanted a custom-made and cloud-based billing system that double up as an electronic claim processing and RCM solution for providers and payers.

DISCUSS YOUR PROJECT

Exploration

Creative Viewpoints For Right Direction

Our target market was not only the dental health service providers but also the payer organizations that wanted to streamline the claim workflow while keeping the patient's data safe.

Our client's emphasis on the accuracy, speed, and optimization of the entire claim processing flow.

Dental claims are of high dollar amounts and involve many codes increasing the complexity of the coding process. OSP started gathering the resources to integrate the EHR systems with the proposed medical billing system.

The lengthy 'backs and forths' between providers and insurance companies increase the denial rate. We identified the journey of single dental health claim from CMS code submissions to the final payment.

While defining the scope of the customized dental billing software system, OSP put stress on feasibility analysis, project management, business analysis, project analysis, user management console development, quality analysis & testing. Our first goal was to find robust encryption to ensure the security of patient's data and its access to only those the client intend to view it over the network. The proposed customized dental health billing system included,

HIPAA compliance
Denial management
Multiple user components

DISCUSS YOUR PROJECT

Analysis

Defining the Solid Roadmap

The primary objective of building the software was to boost the client's claim process workflow. Based on our feasibility report, we decided to come up with the designated user modules to define individual roles throughout the claim process.

We finalized our technology stack and cloud hosting based on the project requirement and the current market trends.

We decided to include the updated ICD-10 and CDT codes in the proposed system with flexible rights to control and update the treatment code.

The client requested to add the intelligent analytics to offer invaluable insights to enhance the system performance.

OSP build separate prototypes for all the different modules that made the whole billing system. Before starting the project, we designed an in-depth system architecture that later helped us to streamline the entire software development life-cycle process. To leverage data from multiple provider information sources, we proposed innovative network designs. Our scalable billing system for the dental FQHCs was offered with some vital features such as

Code-wise payment tracking
Automated Super-bill
Uniform code across biller and reviewer

DISCUSS YOUR PROJECT

Solution

Delivering On the Promise

Dental claims codes are completely different from standard medical claims codes. OSP managed to create a bespoke dental health automated billing system that enhanced the claim processing workflow.

We built a web-based combined version of EHR & Medical Billing system for our client.

Our system was highly customized to target the client's pain points specifically using agile development methods and design-led engineering.

From doctor to FQHC authority, the claim workflow was streamlined, optimized and fully automated to accelerate the claim lifecycle.

Our tailored dental health billing platform follows all the necessary HIPAA compliance standards backed by AWS cloud hosting.

As per the promised custom solutions and integrated features, OSP labs updated the final product with ICD-10 and CDT codes, secure credentialing, next-gen analytics tools and finance management from top to bottom. Our tailored automated billing system assured robust claim support with EOB and ERA modules.

Our final version of billing software solution has the potential to automate 360-degree claim management process for users at every level. The designated roles and functions of individuals involved in FQHC patient registration, medical reports, claim submission, and reimbursement can use the central hub to carry out their assigned tasks efficiently.

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Result

Building to Deliver Experiences

After the initial exploration and assessment, OSP Labs delivered the blueprint of the proposed dental health billing software solution within a week. Our hard work and seamless work strategy allowed us to launch the beta version within four weeks.

During the software life-cycle, we kept the client in the loop to collaborate and ensure the right product delivery on time.

The final automated billing system allowed quicker claim reimbursement by reducing unnecessary code errors.

The billing system helped the client to eliminate multiple medical billers, coders, and reviewer at every step of claim life cycle and reduced the manual billing work.

OSP's automated dental health billing system in the cloud achieved 100% compliance goals with the secured private patient data flow from provider to clearinghouse and payer. The dental FQHC was provided with easy provider network management. Our system made possible managing claim denial with electronic remittance advice, EOB and appeal letters to zero down unpaid bill ratio. OSP made sure the improved ROI by providing automation of entire claim process from submission with CMS codes to reimbursement from FQHC payer.

DISCUSS YOUR PROJECT