Integration with Healthcare & Insurance Companies Case Study

Advanced X12 integration solution streamlines the full connection of our client with insurance providers. Our progressive custom software facilitates secure and fast claim cycles, minimizes the number of non- or partly-paid claims, and empowers efficient business workflows. With the solution, the billing lag has been reduced from 3 months to just 1 day.
insurance integration

About Client

A US-based company is a healthcare vendor with an outstanding services business. Its customers get considerate and attentive assistance empowered by our cutting-edge tech solutions for 24/7 professional support.
Technologies
Java
Spring Boot
Hibernate
AWS
PostgreSQL
Angular
team
a dedicated team of 4 developers
Duration
3 months

Overview

Recent overloads of the healthcare system, which we all witnessed during the pandemic outbreak, expressively demonstrated the vital importance of timely healthcare provision. In the meanwhile, medicare specialists urgently require an innovative technological helping hand to relieve them from an avalanche of tedious workflows, energy-sapping document work, and long claims approvals. The ultimate solution to this difficult task lies in the perspective of reputed integration with healthcare companies approaches.

The groundbreaking X12 integration solution that we developed for our client helps join together all parties involved in comprehensive medicare service. The project provides stable and fast integration and delegates all the formalities to our top-notch custom software. CleverDev Software prides itself on sharing progressive proficiency and enthusiasm for this beneficial solution.

healthcare integration

Business Challenge

A US-based healthcare provider was searching for the best suitable software integration feature to make its forward-looking patient care service more powerful and operative.

Before turning to CleverDev Software, the client had to process claim data manually which involved tons of man hours for sorting all the formalities: all information had to be collected, claim forms filled, and the transactions checked by the specialists of the company. What is more, the approvals, payments, and transaction details could be received with long delays. Overall, the full claim cycle process could have taken up to three months.

Eventually, such a long wait was not an option for the responsive healthcare service of our client. And with the scaling of our client’s business, his team just could not cope with the document work overload.

Consequently, to be tuned with up-to-date business methods of the industry, the company needed robust software for seamless integration with insurance companies, accelerated claim cycles, and new opportunities for business enhancement.

Solution

On that account, our client made the right step to use our second-to-none custom software development expertise. CleverDev Software has accomplished competence in excellence-demanding healthcare software delivery. We always focus on creating perfect tech solutions for our customers’ businesses. Therefore, we implemented the X12 EDI standard integration project to provide the means for outstanding healthcare service for our client.

The CleverDev Software team has created a claim control module — HIS (Health Information System) and seamlessly implemented it in our client’s business workflow. This module sends x12 EDI claim data over an sFTP protocol and returns the response whether the claims were rejected or accepted.

One of the main types of claims we work with is #837 | Institutional and Professional Health Care Claims. We also implemented the EDI 277 Health Care Claim Status Response transactions that are specified by HIPAA for the submission of claim status information and the 835 transaction standard by HIPAA to transfer data about payments and remittances for adjudicated professional and institutional health care claims.

What is more, due to our specialists’ high expertise in working with clearing houses like Availity or Waystar, and also with insurance companies, we leveraged fast and straightforward claims shipping and handling processes. As a part of our powerful remote patient monitoring platform, we build an integration module that sends claims to the clearing houses and also receives back the info on whether the claims were paid or not.

CleverDev Software's team established core X12 integration functionality with the following essential features:

  • Minimal Claim Cycle. The smooth process speeds up the business operations of the company. It also reduces the number of non- or partly-paid claims and enables further rate corrections.
  • Information about Unprocessed Claims. If there are any unprocessed claims, the provider gets a full report about them.
  • Claim Preview and Editing. Any generated claim can be previewed and edited manually if needed.
  • Claim Approval or Declining. When a claim was created according to the price list, the provider can approve or decline it.
  • Claim Updates. A claim can be updated on-the-fly according to the source data.
  • Claim Creation Problems Reports. In case there are any issues with claim creation, the provider gets an immediate detailed report about them.
  • Automatic or Manual Claim Sending. The provider can leverage manual or automatic processes of sending electronic claims.
  • Paper Claim Sending. The feature creates a PDF document of a 1500 Health Insurance Claim form to be filled manually if needed.
  • Claim Sending Problems Reports. The feature automatically creates a PDF document of a 1500 Health Insurance Claim form.
  • Claim Processing Tracking. The feature informs the provider about all the stages of claim processing.

CleverDev Software’s team of outstanding professionals has impressive experience and understanding of challenging and demanding healthcare, financial, and business automation solutions.

The work for this project required implementing our exclusive and mature expertise in X12 EDI (Electronic Data Interchange) and CICA (Context Inspired Component Architecture) standards together with XML schemas. That is why we could guarantee fast and effective project delivery and first-rate project performance for our client.

The X12 integration module was developed and applied to our client’s business workflow in just three months. The CleverDev dedicated team for the project consisted of 4 seasoned specialists.

X12 integration

Results

The innovative X12 EDI standard integration module, built by CleverDev Software, empowered our client’s business with full integration with insurance companies capabilities. It introduced a full range of claim control functionality and moved our client’s medicare service to the upgraded level of business.

The X12 module development and implementation process was successfully delivered by our team in a brief period that took just three months. This remarkable solution provides stable and fast claim cycles, advanced claim control features, streamlined business workflows, and new development potential.

The practical outcomes include:

All Claims Submission

The module guarantees that all the claims about medical services will be submitted without any exceptions within specified by regulators time.

Day by Date Claims Submission

It significantly enhances all the documentation processes and helps avoid unfinished or partly-finished claims and payments.

Detailed Claim Statuses

The specialists can trace all the details about each claim and utilize the data for analyzing and problem solving.

Payment Explanation

The solution also provides in-depth data about payment and transaction details. The provider can sort out all the incoming information and quickly respond to any possible issues.

To summarize all the advantages of our X12 integration module, we want to emphasize that the project was more than just a software delivery process for the CleverDev Software team. We truly take pride in contributing to our client’s business development and progress.

We Are Open to New Projects

If you are interested in developing forward-edge software integration solutions, it is vital to turn to a mature professional as such requires exceptional expertise and skills. CleverDev Software is your exclusive custom software development partner for your integration projects. We will deliver the industry-leading functionality to open new horizons for your business.
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