Tracker: Smarter Claim Management For Healthcare
The Challenge
Before partnering with Remotebase, healthcare providers working with Integrate were relying on Excel spreadsheets to manage insurance claims, resulting in frequent errors and inefficiencies.
Critical steps like negotiation and dispute logging with insurance companies were often missed due to manual oversight, leading to financial losses.
Specifically, claims would sometimes not reach the negotiation stage or fail to meet tight deadlines required by Internal Dispute Resolution Entities (IDRE).
Solution
Remotebase developers collaborated with Integrate to create "Tracker," an automated solution designed for healthcare providers to manage insurance claims efficiently, ensuring healthcare providers don't miss critical stages.
Key features
Automated claims
Automating insurance claim
submissions to prevent missed or
delayed claims.
Regular Notifications
Providing timely alerts for
critical deadlines of negotiations
and disputes.
100% Submission Rate
Ensuring all claims reach negotiation
or dispute stages in time.
Technology used
Backend
Tracker is built on .NET Core and MVC, providing a robust, maintainable backend with efficient routing and scalability for healthcare claims management.
Database
SQL Server is used to store and manage large volumes of claims and negotiation data, ensuring high availability and performance.
API Layer
NestJs is implemented for building scalable APIs, facilitating smooth communication between Tracker and external systems.
AI Integration
OpenAI is integrated to automate the parsing of emails, helping in automating replies and triggering actions in the claims and IDR processes, streamlining workflows and reducing manual intervention.
Email Automation
Microsoft Graph API is used to read emails directly from inboxes, enabling automated processing and handling of claim-related communications, supporting further automation of actions in the workflow.
Scheduling
Schedulers ensure critical processes such as claim negotiations and IDR submissions happen within the designated timeframes (30 days and 4 days, respectively).
Cloud & Deployment
The platform is hosted on Azure services, utilizing resources for scalability and reliability, with Azure Scheduler managing time-sensitive tasks.
Impact
By automating the claim submission process, "Tracker" improved the efficiency and accuracy of claims management, leading to better outcomes for healthcare providers.
Automating paperwork allowed healthcare providers to focus on core responsibilities, drastically reducing time spent on manual claim management.
With every claim being tracked and submitted on time, the success rate of negotiations and disputes improved significantly.
The precise tracking of deadlines ensured no claims were missed, reducing potential financial losses.
