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Healthcare management solution to automate claims processing

Services offered : Application Development

Introduction

Amzur developed an automated and comprehensive healthcare management solution that brings patients, healthcare takers, and insurance providers to the same page without any communication gaps and errors. Amzur’s turnkey solutions make disparate departments work together by embracing modern technology and leveraging data and analytics. Our healthcare management solutions promise that the health system works better for everyone and helps businesses scale up at a pace.

Client Overview

Medical data processing and claim management are crucial parts of the healthcare industry. Manual processing and errors continue to be the biggest hurdles for insurance companies, hospitals, and other providers.

One of our clients from the healthcare industry wanted to develop an inclusive application to automate the documentation process and make the data available across the organization to minimize manual intervention. They approached Amzur to develop a solution to improve drug administration and free up doctors to spend time with patients.

Challenges

Industries are moving at a fast pace to embrace technology and gain the benefits brought by business modernization. The healthcare industry is no exception. Since the healthcare industry is data-sensitive and often requires human interaction, it can be a challenge to implement and achieve automation and process efficiency.

Our client faced challenges with extensive human intervention, tedious task management, real-time viewing of business processes and data, claim processing (which further complicated data processing), disaster management, and cross-department communication.

Solution

Before developing a comprehensive solution, we identified a few customer challenges including, speed, accuracy, transparency, tedious tasks automation, claim processing, and data security.

After a thorough analysis, our team of experts divided the entire development process into three phases to resolve every challenge with the utmost attention.

The three phases are:

Claims management module

Clinical 360 services

Integrated ancillary services

We identified the need for process automation and developed modern healthcare management and automation solutions. For this application, we built:

A configurable rules engine and workflow engines to replace manual operations.

An automated process based on business rules definitions to move erroneous manual tasks to automated tasks.

A process to move repetitive tasks to the business rules engine and workflow engine.

A 360-degree solution that made it possible to provide a single source of truth for data across the organization for better communication.

Our four-tier architecture focuses on improving efficiency while minimizing human intervention and erroneous operations.

Business Access Layer: Contains business logic, and validation that is related to the data.

Data Access Layer: Contains logic for the business layer to connect to the data and performs required actions like insert, delete and update.

Presentation Layer: Contains .asp or HTML and forms the user interface, gives an output from the system, or takes inputs from the user.

Data Standardization Layer: Evaluate incoming claim data and prepare vital information for the processing engine.

Tech Stack

We are always ahead in embracing modern technologies that can ensure prominent growth and scalability.

Angularjs + C# + MVC + Web API + Kendo UI + HTML 5 + CSS 3

Windows Server 2008 was used with IIS 7 that followed MVC architecture

The benefits of MVC architecture are:

It can be integrated easily with Javascript frameworks

MVC architecture provides total control over the rendered HTML

TDD – provides test-driven development

MVC architecture provides total control over the rendered HTML

Benefits

Amzur’s healthcare management system benefits various sectors including, the government, insurance companies, patients, and hospitals in:

Bringing disparate data together to make well-informed decisions

Improving drug administration accuracy by 40%.

Freeing up doctors to spend more time with patients.

Error-free claim verification and processing.

Saving more than 60% of employee time from mundane tasks.

Conclusion

Today, business and process automation have become paramount to stay relevant and competitive in the market. Especially in the
healthcare industry, it is crucial to ensure everyone including, patients, insurance companies, and doctors is free from monotonous and tedious tasks.

Failing to achieve workflow automation and claim processing wouldn’t yield any positive results and only further hinders growth. Our client came to us with numerous challenges to overcome and ideas to implement. By combining our technical expertise and vast industrial experience, we built a futuristic healthcare management application that enables businesses to access real-time data through customized dashboards and provides insights that contribute to seamless growth.

Client’s feedback

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