CASE STUDY

Integrating Healthcare EDIs

Submitting paper insurance claims introduces human errors into the process. A healthcare company was ready to streamline its insurance claim process but had to integrate with an esoteric government system. They needed custom development work to bridge the gap.

01

Problem

Integrating two systems is difficult, but doable. Integrating with a 60-year-old program? Challenging.
02

Solution

Going the extra million lines of code, we’ll find a way to integrate systems together.
03

Results

File insurance claims with confidence, and get every penny you’re owed even faster.
01

The Problem

custom mobile app

Bottlenecked Workflow

A major priority for the Idaho-based company was improving its health insurance claim process. Running a habilitative for-profit company using pen and paper was hampering their scalability. Since the average error rate for insurance paper claims is 28%, the company’s growth was blocked by human errors and processing delays. As part of their business process overhaul, the company prioritized switching from paper claims to an EDI format to securely transmit protected health information (PHI).

With a patient population entirely reliant on the same kind of health insurance, the software that Ventive was building for them needed to seamlessly integrate with Molina Healthcare. Unfortunately, the project quickly hit a snag. The Technical Project Manager realized that even though the EDI integration was only one part of the project, the difficulty of integrating healthcare EDIs could hamper the client’s move away from paper processes.

02

The Solution

Laptop custom web application development

Improved Work Processes

It’s not unusual to have delays in healthcare EDI integrations. That’s one of the reasons entire firms specialize in this type of integration. For smaller companies though, using specialty firms is often cost-prohibitive. As the Ventive team started to automate the company’s insurance claim process, the Technical Project Manager knew he needed to understand the process enough to direct the EDI developer.

Even though the information about integrating with Molina’s system was scattered across technical manuals and online developer forums, the Technical Project Manager decided to learn enough about EDI integration to work closely with the Lead EDI developer. They were able to navigate the vast configurations of EDI attributes and apply the correct service codes to the proper plan of care.

Highlights

Services Utilized

API Integration

End-to-End Testing

Launch Readiness

03

The Result

ballet dance studio recital

Faster Insurance Returns

This EDI integration was only one step in our client’s business transformation, but the difficulty of integrating a system like this could have stalled the project’s progress. Instead, the Ventive team’s ability to adapt and rise to the project’s needs has kept the entire process running smoothly.

The next stage of digital transformation for this company includes building out scheduling, payroll management, and time tracking management for their clients and employees. In the meantime, our client is able to immediately improve how quickly they receive insurance reimbursement, thereby streamlining their processes and improving their cash flow.

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