A large group of clinics needed a customized solution for administrative tasks
In the United States, any visit to a healthcare service center to consult a physician is expensive. If, on the first visit, the Physician deems it necessary for the Patient to be
admitted to a hospital as soon as possible for observation, tests and subsequent treatment, the immediate question arising is: “How much does your Health Insurance cover you for?” Most people will probably not be sure of their answers, and the ones who are might suddenly be daunted by the complexities involved in post-hospitalization claims. For the lucky people without an acute condition, a one or two week wait for insurance authorization might be the way to go- but not without the stress involved in acquiring the
right information over many phone calls and further visits to the physician for the processing of claims related forms.
Challenge
Our client needed a few things. First was a portal for physicians, patients, and claims representatives could access the details of the policy at any time. In order to offer quicker healthcare services to healthcare insurance holders, and to simplify the process for Patients and Physicians alike, Qatalys developed a web-based health plan Administrative System. There were a few key challenges during this project:
- Tight Deadlines
As the health and welfare of numerous people were involved it was important for Qatalys to finish the project but also insure integration is seamless and quick.
- Understanding the Domain
As we were integrating on top of existing systems, it was important we did our due diligence up front. This including how the system would connect to insurance databases.
- Highly Customized
A series of hosted products were also identified to be key to the scope of the project. Additionally the product needed to act within state level compliance laws which vary.
Solution
Qatalys leveraged its established process to build a suitable off-shore technical team from scratch. Post the initial knowledge transfer, Qatalys set-up an exclusive confluence website and an ‘Ongoing Knowledge-Transfer Program’ to provide for the immediate scaling up of the support team to meet the Client’s increasing Market needs; and deliver within tight deadlines. Qatalys’ off-shore team handled bug-fixes, supported product customization in accordance with compliance needs of various States in the US. The enthusiastic Qatalys team has more recently begun participating in development reviews and has helped forecast potential future technical architectural designs.
Results
Qatalys’ bespoke web-based administrative software provided physicians all across the United States immediate access to insurance eligibility information. Patients were able to quickly upload pertinent documents and claims agents could review forms easily. After all was said and done, Qatalys was able to turn a 1 to 2 week processing period down to a single day.
Our off shore model has empowered the client to focus on what matters most: the patient.
