Medical Insurance Claims Processing – A Case Study

Medical Insurance Claims Processing – A Case Study

Posted February 27, 2014 by Carolina
Healthcare Application Development


The client is a leader in the Healthcare industry and their mission is to create a digital ecosystem by leveraging cutting-edge technology to connect a disjointed healthcare industry.

The client approached Chetu to develop a system in order to improve the processing of insurance claims for patients, providers and healthcare professionals.

Business Objective

Chetu had to make use of its healthcare industry expertise to provide a solution for the processing of Health Insurance Claims Transactions in EDI format and Lab Orders and Results in HL7 formats.

Solution From Chetu

Using its vast experience developing healthcare solutions and having knowledge of the latest requirements and formats, Chetu has helped develop various EDI interfaces and services. This solution helps to generate and process the following EDI transactions:

Health Insurance Claims (837)

Health care remittance advice (835)

Eligibility inquiry and response (270 and 271)

Claim status inquiry and response (276 and 277)

Referral and authorization (278)

Generating Claims Form 1500 (Paper Format)

Hospital Claim Form UB 40 (Paper Format)

Similarly, for the processing of Lab Orders and results Chetu has developed an interface/service that allows transactions in HL7 format.

 Results Delivered

The client has been able to successfully integrate the EDI and HL7 interfaces developed by Chetu with their core Practice Management System. This has helped the client increase: collection speed, first pass resolution rate and staff efficiency, while cutting costs and improving gross margin for their end users. The Chetu team is still supporting the client by integrating with various end users of the system and enhancing the Claims Proof mechanism. Having seen the expertise and the cost effective solution delivered, the client has initiated another venture with Chetu: to work on their new EHR offering and get it certified.


Chetu, Inc. does not affect the opinion of this article. Any mention of specific names for software, companies or individuals does not constitute an endorsement from either party unless otherwise specified. All case studies were written with the full cooperation, knowledge and participation of the individuals mentioned.

Chetu's Healthcare team implements solutions for the Healthcare industry. Chetu differentiates itself in providing industry specific expertise combined with its low cost, high productivity model. You can find more information about the portfolio of our Healthcare experience at:

Chetu was incorporated in 2000 and is headquartered in Florida. We deliver World-Class Software Development Solutions serving entrepreneurs to Fortune 500 clients. Our services include process and systems design, package implementation, custom development, business intelligence and reporting, systems integration, as well as testing, maintenance and support.Chetu's expertise spans across the entire IT spectrum.

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