RCM Solution Development For A US Based Health Solutions Developer
To add greater depth to their capabilities with PMS and RCM solutions, the client sought to build a comprehensive but modular solution. Such a system could be used as an independent plug and play solution which seamlessly integrated with a care facility’s EHR system. This solution would cover multiple workflows ranging from patient intake management to denial management using billing reports and authorizations to deliver insights to the user through intuitive dashboards.
The Challenge
Such depth to RCM functionality needed a ‘from the ground up’ approach to designing the solution. This required the development of complex RCM workflows that would need to support different specialities. Integrating RCM workflow processes such as bill generation, claims submissions, secondary claims management, with PMS functions was required while retaining the simplicity of usage. The solution had to be interoperable with multiple EHRs and clearinghouses using HL7, FHIR, EDI, for marketability reasons.
Our Solution
The client chose Nalashaa’s team of healthcare experts to develop and deploy RCM the solution. We equipped the client solution with the following core functionalities.
SaaS Implementation: A diverse software suite with multifaceted functionality would scale and perform well in a cloud-based configuration. Our team of experts chose MS Azure to host the solution. It would help HIPAA compliance, and insulate the customer from repercussions of security breaches thanks to Microsoft’s networking and cloud hosting excellence.
Automation Assistance: Each of the manual processes in the RCM cycle of care facilities would change to follow automated realtime eligibility checks. Activities such as claim generation, denial management and AR follow-ups were bucketized for worklist based auto assignments to billers. It would lead to better throughput and quality control in the billing department.
Claims Management: Scrubbers, edits engine, auto-postings & claim balancing and real-time chat-based co-ordination made the life of billers easier while improving collection percentages. All the important transactions such as eligibility (270/271), claims submissions and ERA (837/35), claims status & acknowledgements (276/77/999).
Paper To EDI Capabilities: The solution had native EDI handling capabilities and talks to multiple clearinghouses such as Trizetto, Availity and many others, out of the box. This allowed providers to choose a clearinghouse of their preference that best suited their practice.
How We Made a Difference
Simplified RCM processes with dashboards and accounts reconciliation.
Improved effectiveness of denial management processes through automation.
As a microservices based cloud solution it allowed for a true pay per use model.
With an intuitive UX, productivity was up by 30% while the training time was reduced.
Technology Stack
- Angular JS 1.6.2
- HTML 5
- Dot Net Framework 4.6
- Entity Framework 6.X
- ASP.Net Identity
- OAuth 2.0
- Web API 2
- SQL Server Standard
- Azure Cloud
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