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Implemented FHIR to improve efficiency in eligibility determination and claims management process


Client Background

The client is a leading RCM company with a client base of more than 150+ hospitals, physician-specialist groups, independent labs, radiology centers, and other providers


  • Improve the operational and financial efficiency of the eligibility determination application
  • Design a simplified and automated process for claims administration
  • Create an FHIR server for EHIR certification for the client’s PMS system to ensure secure data transfers in the format prescribed by HL7 FHIR


  • Implemented the eligibility determination application by using the Eligibility Request and Eligibility Response resources
  • Configured the resources that informed the client about a patient’s eligibility during an episode of care and the cost incurred before the claim is made
  • The desired claims administration system was implemented using claim and claim response resources
  • Created FHIR Server for electronic transfer of data through secure APIs

Tools & Technologies

Microsoft .NET, Microsoft SQL Server, HL7 FHIR Foundation

Key benefits

  • Implementing FHIR saved the overall development and operational costs
  • Improved customer satisfaction
  • Increased the efficiency of the eligibility determination application
  • Tripled the processing capacity of claims
  • Client’s EHR got certified the first time
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