Healthcare Claims Management SAAS Platform

A customer has tasked Cyfrania with building an EMS web application designed to make insurance billing for healthcare services more efficient. The app must work on its own or alongside the customer’s existing EMS tools to improve workflow.

Key Billing Issues That Had to Be Solved by the App

The customer knew their audience faced many billing challenges and planned to address them with their upcoming app. They are as follows:

• Billing involves lots of paperwork or the use of multiple apps.
• Filing insurance claims involves a lot of manual data entry, causing significant effort, frequent redundancy, and human errors that can lead to claim rejection or payment delays.
• Current market healthcare claims management apps are costly, too complex and require extensive staff training.
• Current apps don't meet the EMS sector's needs - they struggle with adding required services, payers, users, and generating custom reports.

Cyfrania’s team of two developers dedicated two years to this project, partnering with the customer to methodically design, build, test, and perfect the system, aiming to satisfy the billing demands of EMS organizations completely.

Key App Features

Below are described the core capabilities this billing app provides to field medical personnel, supervisory staff, administrators, and any other stakeholders within an EMS agency's documentation system.

One-Click Lookup, Auto-Import, and Auto-Filling of Essential Claims Data:

• Ability to import patient data and medical services details from most electronic patient care reporting (ePCR) software used by EMS providers.
• Auto-populating procedure codes with US National Emergency Medical Services Information System (NEMSIS) data.
• Ability to search in public records databases to find missing patient information, such as addresses, social security numbers, or birth dates.
• Upfront verification of patient’s insurance eligibility by searching the region's top payers for missing coverage information.
• One-click generation of ready-to-bill claims in most cases.
• Ability to process claims in bulk and automatically generate secondary and subsequent invoices.

Clean-Claim Optimization Using a Built-in Electronic Data Interchange (EDI) Tool:

• Checking all necessary information is ready for billing a claim to the right payer.
• Forwarding incomplete or incorrect claims to operations for solving and keeping track of denied claims.

Clearinghouse Services Integrated:

• Integration with the clearinghouse that bridges all major government and private payers within the EMS industry of the US healthcare framework.
• Automated claim submissions, keeping track of electronic remittances, and overseeing revenue and payment cycles.

Built-in Forecasting and Reporting Tools:

• Tailor-made and on-demand reporting for performance; evaluating accounts receivable against collections metrics.
• Revenues and cash flow forecasting. 

Regulatory Compliance and Enterprise-Level Security:

• Administrative access controls meet HIPAA and HITECH requirements, the US laws governing protected health information handling by healthcare providers.
• Procedure codes are assigned based on the International Classification of Diseases 10th Revision (ICD-10) following industry standards.

Swift Performance, User-Oriented Interface, and Flexible Customization:

• Operates on Amazon Web Services (AWS), a secure and reliable platform, favored by a lot of hospitals and major insurance providers.
• Offers a user-friendly and intuitive interface, easy to learn and deploy, necessitating minimal staff training.
• Supports an unlimited number of users and allows for adding custom payers and procedures.

The platform gained significant popularity, attracting thousands of EMS providers across the US, whose annual insurance claim collections exceed $1 billion.

EMS providers claim the app helps them deliver a higher service quality to patients by identifying the right payer for costs and by offering various payment options to suit the patient's circumstances.

Advantages Gained by EMS Providers Using the App:

1. Achieving a 99% clean-claims rate right from the first submission while cutting the claim processing time in half.
2. Reductions in administrative overhead and an increase in revenue from the first weeks after the app's implementation.

It happens by dramatically decreasing the time invested in fixing claims, pursuing rejections, tracking the suitable insurance for billing, and seeking information from patients and families focused on recovery. This efficiency improvement results in faster payments and equips EMS businesses to excel in the competitive industry environment.