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Telemedicine Radiology Application
Insurance Claims Processor
Dental Clearinghouse Solution
Professional Claims Clearinghouse
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| Here are some case studies of Projects that we have executed. |
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Project: Telemedicine Radiology Application
Objective: Radiology Application is a service based Web Application done for a USA based client.
Method: Radiology Application consists of three modules:
- Admin - Administrator creates the various hospitals and physicians that participate in this system. Admin consists of accounting, reporting and administering roles.
- Hospital - This application is used to create radiology work orders for the patients being attended.
- Physician - Physician view's the work orders and generates reports or addendums. These reports get faxed to hospital that generated the original work order seamlessly by this application.
This application is setup by an administrator. Several hospitals and radiologists that are geographically dispersed are expected to use this system. This system is expected to process 25,000 radiology claims per year. One of the key features is the web based Fax Interface that allows seamless transmission of Faxes from this application.
Technology Used: HTML, JSP, Core Java, MySQL Server, J2EE 1.3, JDBC, Windows NT, Linux, Fax Interface. |
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Project: Insurance Claims Processor
Objective: To create a Web Application for submission of HCFA Print Image files and 837P files from web based provider accounts; to process batch files into claims in conjunction with internal scrubbing features and to produce a resubmission of claims using HCFA-1500 look-alike forms.
Method: This application consists of four modules.
- Admin - Administrator creates various Provider and Operator accounts, manages the various daily "scrubbed" resubmitted batches.
- Provider and Practice Users - The providers and the practice users submit electronic claims as HCFA Print Image and 837P files; manages their batches by reviewing error claims, scrubbing and resubmitting them.
- Operator - The operators have the same features as an administrator without the privileges to create and manage providers/practice users.
expEDIum backend components - These components provide processing of HCFA Print Images and 837Ps into its constituent claims, perform data enrichment, perform L1, l2 & L3 validation on claims and provide Payer specific edits on each claim.
Technology Used: MVC Architecture, HTML, JSP, J2EE, Java, JDBC, EJB, Jboss Application Server, PostgreSQL. |
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Project: Dental Clearinghouse Solution
Objective: A dental Clearinghouse needed to process a variety of healthcare formats namely - Dental Claims (837D), Functional Acknowledgements (997), Eligibility Inquiries (270), Eligibility Responses (271) and Unsolicited Claim Status Responses (277U); needed encrypting of data, either using PGP or ZIP with password, viewing of statuses and automated unattended processing without user intervention, being able to process several thousand files a day.
Method: iTech delivered a customized expEDIum Claims Reconciliation (eCR) solution with one server license with adapters for processing 837D, 270/271 and 277. This solution also included a customized "Process view" that suited the client need to be able to browse and inspect file specific details. This solution is being used with over 50 payer profiles at this time. Each Payer profile was configured to have a combination of process steps such as Secure FTP Download, Unzip with Password, PGP Decrypt, Process/Reconcile, PGP Encrypt, Zip with Password and Secure FTP Upload. This installation is processing over 5000 files a day and 100,000 files a month in an automated unattended server.
Technology Used: Java, JDBC, MySQL, Third party encryption and connectivity tools and libraries. |
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Project: Professional Claims Clearinghouse
Objective: An Oregon, USA based Clearinghouse that handles several thousand claims a day from a variety of practices, billing services and clearinghouses had an existing system that did not have a web based provider interface, was cumbersome in some respects requiring quite a bit of manual data entry and handling. The system was using legacy technologies.
They needed to replace their existing system using newer technologies, a more efficient system that had web based client access for practices, billing services and clearinghouses. They also needed handling of variety of claim formats such as NSF 3.01, HCFA Print Image, 837P and CSV Files, Payer code based data enrichment, HCFA Paper printing and Payer Ready EDI file creation bundling claims based on some routing rules. In addition, they needed Payer lookup containing all Payers their clients dealt with Patient Demographics capture and lookup for their Practice clients.
Method: iTech delivered expEDIum Claims Portal powered by various expEDIum Portal Components that included batch components that did 837P, NSF 3.01, HCFA Print Image and CSV File processing, L1, L2 & L3 components and an extensible Payer Edit component. The solution also includes a Patient Demographics feature and a Route Manager that perform s HCFA Paper printing and EDI file creation based on some rules. The reports module had a variety of customizable reports based on various filters and Report totals that summed up activity for a given period across all their clients. This solution internally used various expEDIum Transformation Adapters, expEDIum Thin Engine and expEDIum Validation Engine. The whole project was delivered in about 6 elapsed months and at 40% of the total estimated cost compared to other competing solutions.
This solution allows submission of HCFA Print Image, 837P, NSF 3.01, HCFA CSV files from web based accounts that consist of Practices, Billing Services and Clearinghouses. The engine automatically processes batch files into claims in conjunction with internal editing features, produces a validation error list and allows resubmission of claims using a HCFA 1500 look-alike form. The expEDIum solution also performs some claim scrubbing functions and payer specific rule validation before the claim is ready to be bundled as Payer ready EDI files.
Technology Used: The solution is J2EE compatible and used JBoss application server and PostgreSQL DBMS |
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