The Challenge
Healthcare billing operations were manual across Medicare and private payer claim processing, institutional billing and the Notice of Admission workflow. The claims lifecycle needed automated eligibility verification to cut manual effort and claim errors, and every new clearing house integration meant building the connection from scratch.
Medicare and payer claims handled by hand.
Eligibility unverified before a claim went out.
Each clearing house built as a one-off.
Financial and patient records needing protected handling.
Approach & Solution
smartData designed the module around a reusable orchestration layer abstracting billing, claims, eligibility and reimbursement, so common capability is implemented once rather than per payer. Parsers and validators generate requests and interpret responses for each connected clearing house, integrated into the client's existing platform.
The work was delivered by a team working alongside the client's own engineers rather than replacing them, extending the platform in place. Compliant handling of financial and patient billing data was built into the module, and the orchestration layer is reusable for future payer integrations.
Key Features
One layer handling multiple payer connections.
Coverage verified before a claim is raised.
Institutional billing workflow automated end to end.
Financial and patient records protected throughout.
Product Showcase
Final Outcome
Eligibility is verified before submission rather than discovered afterwards, institutional billing and admission notices run automatically, and adding another clearing house is now an adapter rather than a rebuild of the integration.
