Clearing House HIPAA Application

Client

The client, based in New York, is one of the biggest medical billing clearing house firms in the . They specialize in medical claims submissions to Medicare, Medicaid and other HMOs. Their customer base includes a large number of doctors and medical practitioners all over.

Business Requirements

As per HIPAA regulations provided by FDA, the legacy medical claim submitted has to be made HIPAA compliant. This requires electronic claims submission (using EDI) etc. in HIPAA compliant and predefined formats. The client needed a web based medical billing application that is HIPAA compliant. Medical Practitioners would use the web application to login and submit their claims. The admin then submits these claims using the application .

Solution

iSummation Technologies provided a web based medical billing application which caters to all the functionality and HIPAA regulatory needs of the client. The application consists of two parts .

Front end

The front end of the application is used by medical practitioners and their staff to submit medical claims. The application has separate logins for a doctor and his staff to enable different privileges to each according to their profile.

On entering the application the user can enter a new claim, view previous claims, patient records, billing statements etc. Also a detailed report feature is provided to view the records graphically. The user can also view patient profile, patient statement, Day sheets, super bills etc. A concise view on the login page gives a summary of various claims statistics like total claims, sent claims, paid claims etc.

Back end

The backend is used by the clearing house administrator and staff members for claim submission. The admin and the staff members have different access rights based on their profile privileges. Upon logging in the application, the user can see a summary of all claims and member statistics. Faxed claims can be entered manually at the backend by the admin.

The data handled by the application is of all covered and non-covered entities like Providers/Doctors, Payers/Insurance Company, Patients/Subscribers. All this data is maintained and manipulated by the application. Data like procedure codes, its modifiers, place of service, facility & labs etc is also maintained. Finally an 837 Professional claim is generated in purely EDI format according to HIPAA rule.

A submitter can set charges for each Payer as well as can set discount (%) for Providers/Doctors. He will have full fledged billing and reporting facilities in the application. Provision to detect and submit result of 997 FA (functional acknowledgement) and 835 RA (Remittance Advise) in the application is also present. The application can also create batches with the no. of claims wanted for any Payer. Two or more Payers can also be set into single group. Receivers include Medicare, Medicaid etc.

Technology

If you need a Web based medical claims billing and processing software or Hipaa compliant software for a clearinghouse or To Outsource Coldfusion e commerce, ColdFusion programming, ColdFusion CMS or any other kind of ColdFusion software, please contact us. We can make available Coldfusion Programmer or a team of Coldfusion Programmers and web debelopers  for ColdFusion development and support.

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