HEALTHCARE COMPANY EVOLVES INSURANCE CLAIMS PROCESS WITH EDI TECHNOLOGY

DIGITALIZING HEALTHCARE PROCESSES

The client is a leader in the healthcare industry, responsible for matching medical operations with robust technological solutions that greatly improve internal efficiencies and combat infrastructural shortcomings. Their mission is to create a cohesive digital ecosystem, leveraging the latest coding techniques to unify disparate processes.

After exhausting their internal bandwidth, the client recruited Chetu to overtake their developmental needs. In order to form a centralized system, the client was looking to improve their preexisting insurance claims processing protocol for patients, providers and healthcare professionals.

USING EDI AND HL7 FORMAT TO STREAMLINE CLAIMS PROCESSING

The project required EDI and HL7 formatting; claims processing mechanisms favored EDI and the lab orders and results demanded HL7. The solution was designed to generate and process the following EDI transactions:

• Health Insurance Claims (837)

• Healthcare 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)

Chetu instrumented a similar architecture for the processing of lab orders and results, engineering an interface/service that allows transactions in HL7 format.

CHETU: EDI SPECIALIST AND ROI EXTRAORDINAIRE

After receiving the final source code, the client was able to successfully integrate the EDI and HL7 interfaces with their core Practice Management System. This integration has allowed the client to increase collection speed, resolution rate, and staff efficiency while cutting costs and improving gross margin for their end users. In other words, after applying Chetu's code the client has already witnessed profound impacts on ROI.

The indisputable benefit to outsourcing their development led the client to continue their relationship with Chetu. The Chetu team continues to support the client through claims proof optimization and system integrations services. Through the continued success, the client has initiated an additional venture, a project designed to revive their new electronic health records (EHRs) offerings, certifying their selection for institutional use.