Automating Processes for the Middlemen b/w Business & Insurance Companies

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THE CLIENT

If companies don’t want to pay for, negotiate, or maintain relationships with an insurance provider and therefore engage an insurance broker. This is the role of our client. They serve as a middleman between insurance companies and companies by selling insurance and soliciting it through their clients to receive the payment.

Our client develops plans, implements, and oversees employee benefits programs for businesses. They handle claims, create plans, manage the customer service of members, and many more. They remove the burden of insurance plans for business firms while expanding the reach of insurance providers they work with.

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THE BUSINESS NEED

When a patient requires a medical procedure or medication. A pre-certification procedure is carried out to make sure that the insurance company of the patient will pay for the healthcare services they’ll get. Our client serves as a bridge between the insurance provider and the requestor to ensure that the patient is eligible for the treatment and that their treatment is insured.

Our client currently is unable to generate the required XML file as their employees are required to input data and verify the data manually. This endeavor aimed to create an automated process so that data can be verified and transformed without manually input by the user.

WHAT BLU TECHNOSOFT DID

Based on the needs of our clients the group set off to accomplish the following tasks:

  • Automatically run eligibility tests on any information from the insurance company
  • Data is saved in databases with the correct columns as a consequence of accurate mapping and translation
  • Create file outputs based on the information provided by the insurance company as well as any additional information our client wishes to add

Our team first mapped the fields of insurance companies’ databases to the database of our client. Once this was completed we were able to perform eligibility testing on the patient’s details in an automatic way.

If a patient has cleared eligibility tests We then utilized the data stored within the databases to produce the XML file that could then be transferred to the third-party claims system, and then transferred to the appropriate insurance provider. The automated process replaces the manual input of data into the fields of the claims system which saved the employees of our clients time and energy.

The results

It was finished within the timeframe and all goals were achieved. Instead of manually entering the information regarding all four vendors, the client is now able to automatically convert vendor data into XML files. Then, they can upload the XML documents into their third-party claim system and send them back to the insurance companies.

We successfully eliminated many steps from a previously complicated process, helping employees save time and avoiding errors in manual entry, leading to an efficient company overall. Our client now has an online solution that makes their pre-certification process quicker and more secure.

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