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Web based HIPAA medical claims billing & processing software - Clearing house application
The client, based in New York, is one of the biggest medical billing clearing house firms in the US. 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.
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 software that is HIPAA compliant. Medical Practitioners would use the web software to login and submit their claims. The admin then submits these claims using the software.
ISummation Technologies provided a web based medical billing software which caters to all the functionality and HIPAA regulatory needs of the client. The software consists of two parts.
Front end
The front end of the medical claims submission software is used by medical practitioners and their staff to submit medical claims. The software has separate logins for a doctor and his staff to enable different privileges to each according to their profile.
On entering the software 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 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 software, the user can see a summary of all claims and member statistics. Faxed claims can be entered manually at the backend by the admin.
