Challenge

Our customer is a US-based leading company of Transportation and Language (translation) services operating in various countries. They aim to create a smart software web application providing all in one service to multiple businesses. Their primary objective is to create centralized business software that can access every single business process 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
  • Common 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
  • UI and automated report generation using graphs/charts for easy data management

Expertise

  • expertise-tools

    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, TatvaSoft’s experts developed a web-based solution that supports multiple backend services and manages all internal and external processes of the client.

Enlisted are some of the desirable features provided by TatvaSoft

  • 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.
  • Provide 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 life-cycle of an appointment from creation to 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
  • Client asked TatvaSoft to implement any number of automation process that improves productivity and reduce 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 an 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 multiple 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
  • Management reports to review quality, productivity, sales, services, accounting
  • 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 TatvaSoft’s Solution, the client is now able to simplify and integrate the entire inbound services, operations, billing, and sales processes on a single software solution. The client can now automate the billing process and reduce manual efforts, minimize hardware and work location dependency through digitalization. Our digital solution offered multiple features such as web calling which would improve response time and faster resolve 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 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 calls, automatic follow-ups, automatic ride-booking system- all done on a centralized platform.

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