About the Client

The Client is a billing and practice management company, processing over 800,000 claims annually for anesthesia providers across the country. The client’s industry-leading technology and strong commitment to customer service helps to streamline and improve practice revenue for its customers.

Some of the services the client offers include development of charge/reimbursement benchmarks, claim submissions processing, automated payment validation and line item payment posting, and automated identification and correction of underpayments/overpayments.

Business Challenge

The client had an existing Windows application for claims submission, requiring application installation on every user’s machine. Remote vendors had to login to the terminal servers to access the application. This led to maintenance and update issues.

Also the application supported only ICD-9 Diagnosis Codes (International Classification of Disease) and not the latest ICD-10 standards.  Another challenge with the application was that payment posting had to be done manually, by using EOBs (Explanation of Benefits) received from the Clearing House.

Silicus Solution

Silicus converted the Windows application to a Web based one, using Angular JS 1.3 for the front end, the .NET framework for the middleware and back-end, supported by Web API’s that enabled anytime, anywhere access.

ICD-10 Diagnosis Codes were integrated within the application so as to conform to the latest standards.

Payment posting was automated through a Windows Service that will generate and parse 837 EDI files and post the payment into the system electronically.

The application faciliated the following functional workflows :

  • Hospitals send scanned copies contanining patients & treatment details to the Electronic Claim Processing System via a 3rd party tool - Annotator, a Windows Application  used to read the patient & treatment information.
  • Data entry / Coding was made into the new web based Perioperative Information Billing System(PIBS), specifically, Charge Entry , Ledger Information, Manual Payment Posting for the master items.
  • Patient & treatment details are converted into 837 EDI (Electronic Data Interchange) files through the Windows service developed by Silicus
  • The 837 EDI files are sent to a 3rd Party Claims Clearing House on their SFTP location for further processing (Using SQL Server JOBs and Windows Tools)
  • The Windows Service reads the 835 EDI files from the Claim Clearing House FTP location and posts the payment details into the web application

Technologies Used

FRONT END / UI LAYER
FRONT END / UI LAYER

Angular JS 1.3, JavaScript, CSS, HTML

Framework
CORE Framework

NET 4.5, Web API 2.0, Entity Framework

Programming
Programming

Microsoft.NET 4.5, C#

Database
Database

SQL Server 2008 R2, SQL Stored Procedures, SQL JOBS

Backend Jobs
Backend Jobs

Visual Studio 2013

Development Environment
Development Environment

Visual Studio 2013

Client Benefits

Improved Accessibility

By converting the existing Windows application to a Web based one, Silicus reduced the application dependency on a specific machine or workstation. The application could be accessed from anywhere via a web browser and an internet connection.

Support for ICD-10 Diagnosis codes

System is now supporting ICD-10 Diagnosis codes for the Claim Processing.

Improved Productivity

The Windows service allowed payments to be posted electronically, reducing manual efforts.

Reduced Maintenance Overheads

The application could be seamlessly modified and deployed to the production environment without installing the updates on every machine.

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