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Overview / Health Care

INDUSTRY

Optimizing B2B in Healthcare

Today, Healthcare providers are tasked with the staggering challenge of cutting costs while continuously providing quality clinical patient care.


UltimoSoft has built an international reputation in providing reliable, cost-efficient, and secure technology services in the Healthcare sector. As the only consulting partner of Edifecs, creators of a powerful set of Healthcare applications, tools and technologies, UltimoSoft is uniquely positioned to provide service leadership and expertise. We offer complete life cycle B2B implementations.

In concert with your organization, we provide the essential consulting link that removes barriers between Healthcare enterprises, optimizing your financial, administrative, reporting, compliance, and pharmaceutical digital data communications and cutting operating costs. UltimoSoft Healthcare experts help you define, monitor, troubleshoot, route, and record all your transactions.

Health Care Diagram

Solve challenges in:

  • Accountability of Claims
  • Claims Lifecycle Management
  • Lack of visibility into EDI Operations
  • Identification and Error Tracking
  • Consistency, Accuracy, and Quality of Processing Claims
  • SLA Compliance - Increased Fines and Finance Charges
  • Manual Distribution and Mishandled Claims
  • Real time and Dynamic reporting
  • Management control and visibility of work distribution
  • Claim Audit Trail
  • Customer Satisfaction
  • Claim control from time of receipt to time of realization
  • Work Prioritization and Assignments
Our Healthcare Solutions Include:

  • Healthcare Payer and Provider Institutional and Professional
  • HIPAA-compliant Claims
  • Management and Real-time Visibility
  • Healthcare Call Center Integration for HIPAA-compliant
  • Eligibility, Benefits and Claims Management
  • Healthcare Broker Portals for improved CRM
  • Healthcare B2B Integration
  • BPM solution for Claim Adjudication
Our healthcare clients include Tennessee Healthcare, Sisters of Mercy, United Healthcare / Golden Rule Insurance, BCBS of Kansas City, BCBS of Maryland, Department of Veterans Affairs, Centene, Tufts Healthplan.

Case Studies
Our projects include:

Business to Business Integration - HIPAA Scenarios
UltimoSoft has excellent experience in implementing B2B integration solutions in Healthcare, Logistics, and Manufacturing verticals using EDI-X12, HIPAA, Rosetta Net, and SOAP.

CareFirst
CareFirst is the largest health care insurer in the Mid-Atlantic region, serving nearly 3 million members. Customers include more than 80 percent of all of the Maryland/D.C./Northern Virginia region health care providers participating in one or more of its provider networks.

Projects at Carefirst
  • B2B integration at Carefirst
  • Call Center Integration for Eligibility/Benefits/Claims inquiry

B2B integration
Electronic claims are submitted to CareFirst and CareFirst BlueChoice by physicians and hospitals through one of their preferred vendors or by billing agents, vendors, or clearinghouses. CareFirst has approximately eight trading partners, including Emdeon, MedAvant, MTrans, Payerpath, Per-Se Technologies, and Professional Management Group.

UltimoSoft is involved in building a B2B solution for Carefirst using TIBCO suite of products such as BusinessConnect, BusinessWorks and Adapters. This solution includes building Data warehousing and Business Intelligence reporting solution, SLA tracking for adjudication of claims, auditing services, error handling services, and duplicate detection processing. It is expected that this project will ensure faster and more accurate claims processing, resulting in higher customer satisfaction and better revenues.

Call Center Integration for Eligibility/Benefits/Claims inquiry
CareFrist uses Epiphany CRM for managing the call center. The eligibility, benefits and claims data is stored in different mainframe-based systems. There is need for integration of Epiphany CRM with several back-office systems for member data synchronization and Eligibility, Benefits and Claims inquires.

UltimoSoft is involved in building integration solution based on SOA architecture for integrating Epiphany with back-office systems. TIBCO products such as BusinessWorks and Adapters are being used for integration. This is a very high-volume and high-response requirement application. UltimoSoft provided Architecture, Design and Development services that include providing of Logical Architecture, Conceptual Architecture, Monitoring Strategy, Operations Strategy, Capacity Planning, and Deployment Strategy. It is expected that this project will improve the productivity of the call center representatives/consultants and better customer service.



 

 

 

 

 

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