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
