Client

Industry: Healthcare & Insurance

The client is based in USA and is actively engaged in Transportation and language sector. It is leading its way in providing the transportation service to the injured people (patient) to the hospital, who are having the claim against it from the insurance company.


Challenge

The client wished to create a highly complex as well as software-as-a-web based application which can work as a mediator between the Insurance Company (Payor) and Injured worker (patient). The aims were to provide and maintain transportation service to the IW who has the medical claim against Payor in a single tool, out of which the prime challenges faced to consider the client requirement are listed below:

  • Fetching claim from client SFTP and insert into SQL server.
  • Generate Billing invoice from SQL server and Convert it into the flat file and put on client SFTP.
  • Complex Flat file schema Generation using Flat File wizard with positional Record.
  • Connect Client SFTP using BizTalk SFTP adapter.
  • Making custom Receive pipeline Components and Send pipeline components.
  • Insert the record into SQL server using WCF LOA adapter.
  • Error handling using orchestration.
  • Facility to send email alert for any failed message during process large file.

Solution

TatvaSoft has developed web-based solution that provides the service in Transportations and logistics industries, by acting as mediocre between Injured Worker (IW) & Payor with the following features:

  • Maintain all the basic information related to Payor which can be classified as Insurance Company, TPA (Third Party Admin), NCM Companies (Nurse Case Manager), Employer, National Network.
  • Assigning the User (company agent) to the injured worker with all the details under Payor.
  • Generation of the appointment/referral to keep track of all appointments of patients. As patients get familiar with our client, they would start giving information about their future appointments to the client. In that case, our client would come to know about the appointments from the Patients, not the Payor.
  • Inbuilt Generic email template creation for different purpose like notify the appointment, Billing related details, Claim which will be referred to Payor, Submit invoice to Payor etc.
  • Generation of the reports for various sectors like finance, sales, Account, marketing etc.
  • EDI was taken into consideration for exchanging the data related to the electronic media.
  • To provide the external PRIME Services as per the Injured Worker coins for,
    • TL (Translation)-Maintain the language based services like On-site, Conference call, Document etc.
    • TR (Transportation)-Maintain the different facilities like AMB (Ambulatory), WC (Wheel Chair), NES (Non-Emergency Stretcher), ALS (Assisted Life Support), BLS (Basic Life Support) etc.
  • Maintain the different Queues (appointment cycle), employee description and automated calls related to Queues. At organization the Queues is parted in different steps like Intake Queues, dispatch Queues, Confirm Queues, and Email Queues etc.
  • Automation in billing with details like Per Mile, Wait time, Back time. The output can also be generated in Pdf and Excel Sheet.

Technology

  • Tools & Technologies : ASP.Net, Microsoft C#.Net, ASP Telerik Controls & Reports, nSoftware, Twilio
  • Framework : Microsoft .Net Framework
  • Database : Microsoft SQL Server
  • Server : IIS

Result

The client was able to streamline the entire transportation service process to the IW who has the medical claim against payer in a single tool. Client drew many benefits with association with TatvaSoft that include seamless integration with client SFTP, Making custom Receive/ send pipeline components, Automation in Billing etc.

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