2400 Meadowbrook Parkway, Duluth, GA 30096 | +1 770-493-5588 Follow Us
Select Page

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

Challenges

  • 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

Solutions

  • 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
Case Study KeyPoints

    captcha

    Services

    Digital Product Engineering

    Cloud Services

    Data & Analytics

    Intelligent Automation

    Cyber Security

    Build Operate Transfer

    Talent Solutions

    Industries

    Banking & Financial Services

    Communication, Media
    and Technology

    Energy and Utilities

    Healthcare

    Life Sciences

    Manufacturing

    Retail

    Transportation and Logistics

    Travel & Hospitality

    Innovation @ Work

    Blogs and Insights

    Research and Whitepapers

    Case Studies

    Company

    About Us

    Leadership

    Strategic Partnerships

    Office Locations

    News and Events

    The Foundation

    Careers

    Open Positions

    Life @ Innova Solutions
    Candidate Resource Library

    Let's Connect