Insurance & Transport Integrated Web Application - Case Study

Challenge

The customer is a leading US-based company of Transportation and Language (translation) services operating in various countries. They aimed to create a web application providing all in one service to multiple businesses. Their primary objective was to create centralized business software that can access every single business process. This included handling multiple entities such as Insurance company (Payor), Injured worker (Patient), service providers, and client’s internal operations.

Critical challenges faced by the client

Process eligibility (claim) files of different file formats (Flat file, spreadsheet, EDI) extracted from multiple Payors from BizTalk
Single interface to manage Payor, users like agents, providers and their subsequent details, services, and billing information and rules
Referral (appointment) interface to manage all details of transportation/translation service on a single platform
Dedicated queues to work on for different teams like Service, Operations, Quality, Billing
Maximum automation features to increase productivity, quality and reduce human errors in areas such as Operations and billing
Comprehensive UI and automated report generation using graphs/charts for easy data management

Expertise

Tools & Technology

.NET • .NET core • Asp.NET MVC • JavaScript • React • Biztalk • jQuery • C# • Microsoft SQL server • Microsoft Graph API • CSS • bootstrap • Telerik controls and reports • nsoftware • Twilio • Lyft • Google API

Solution

Considering the requirements of the client, sysgenpro’s .NET development team created a web-based solution using C# and React that supports multiple backend services and manages all internal and external processes of the client.

Enlisted are some of the desirable features provided by sysgenpro's web app:

Centralized interface to manage multiple entity information such as Payors, users, third-party providers, and their intricate details, state/county wise pricing, service number, billing cycle details, and more.
Provides BizTalk EDI solutions to download claim details from the Payor’s network, import into database, and interface to display claim details associated with Injured Worker (IW).
A single platform to manage the applintment life-cycle from creation, reconciliation to final receiving of payment from the Payor.
This interface specifically manages Transportation services like Ambulatory services, Wheelchair, Air ambulance, and Translation services like Onsite (regular, certified, legal), conference call specific details
sysgenpro implemented a number of automation process that improved productivity and reduced human dependency

Solution Benefits

Automated mileage calculation (Google APIs) based on destination and travel time.
Automated cost-effective solution to book ride from Lyft, Uber, and other local providers.
Automated communications at different stages of the appointment using generic email templates
Different task queue interfaces dedicated to a team like intake, service, care, operations, billing etc. to work on and smart task assignment rules
Interactive voice response (IVR), dial/receive calls over browser to reduce hardware dependency and create dynamic call routing
Automated Calls/SMS/Fax using Twilio with IW for various purposes like confirmation/reschedule an appointment, talk to representatives, surveys, etc.
Interface to load emails on-screen using office 365 Graph APIs and related actions
Automated invoice generation in various formats like PDF, spreadsheet, XML, tab-based txt, etc., Auto reconciliation and Auto follow-up process
Following US health standards to generate EDI 837, 277, 999 files through BizTalk
System generated management reports to review quality, productivity, sales, services, accounting in real-time
Dedicated provider portal where they can log-in and review services assigned to them, accept pending or assigned tasks, payment check status, submit queries, etc

Result

With sysgenpro’s web-based Solution, the client was now able to simplify and integrate the entire inbound services, operations, billing, and sales processes on a single software solution. The client could automate the billing process, reduce manual efforts, minimize hardware and work location dependency through digitalization. sysgenpro’s digital solution offered multiple features such as web calling which improved response time and resulted in faster resolution of customer queries.

The client will no longer have to switch back and forth between multiple software/hardware like outlook, phone systems, and the sure-shot credit goes to our cutting-edge innovative solution that brings everything on a single platform. The client’s business is now able to increase per day referral process and productivity drastically by switching to automatic call answering, automatic follow-ups, automatic ride-booking system- all done on a centralized platform.