About the project

Modernizing Medicine provides an all-in-one, electronic health record system, practice management, and revenue cycle management solutions to healthcare practices. The company required a custom module to better handle the intricacies of claim management.

Modernizing Medicine approached us because they were grappling with several challenges in their claim management processes. Their main problem revolved around managing the complexity of claim workflows, which involved multiple user roles. They needed a solution that could effectively handle these intricate workflows and ensure seamless coordination between different users.

Additionally, they sought assistance in ensuring secure file handling and encryption to protect sensitive data. Another aspect they wanted to address was the need for an intuitive and user-friendly interface for efficient navigation and file management. Lastly, Modernizing Medicine was keen on facilitating real-time communication to expedite problem-solving during claim processing.

They recognized the importance of timely collaboration and sought our expertise to develop a solution that would fulfill all these needs and requirements.

Challenges

One of the main challenges was understanding the intricacies of claim management. We had to gain a deep understanding of Modernizing Medicine’s existing systems and processes related to claim management. This involved comprehending the complex workflows and requirements specific to the healthcare industry.

Also, one of the points that had to be handled with caution was the aspect data security and compliance in the healthcare sector. We needed to implement stringent measures to protect sensitive data and financial information, including secure file handling, encryption, and adherence to relevant privacy regulations.

Solution

To address the primary requirements of ModMed’s, our team developed the Claims module, which included the following features:

Tailored Role Access: In response to ModMed’s requirements, we implemented two new user roles: “Off Shore” and “ModMed Staff.” These roles were specifically designed to limit access to the Claims module, ensuring that only relevant personnel could access and manage sensitive data.

File Management and Security: We developed a secure, client-side encryption system for file uploads, coupled with a comprehensive audit trail. A file status system was implemented to track the progress of each file from upload to completion, ensuring that files could be easily managed and retrieved when needed. To enhance data protection, we made sure that completed files were physically removed from the server after download.

Intuitive User Interface: We ensured that the user interface was intuitive and easy to navigate. Our team provided a method for users to easily filter and find uploaded files based on various parameters such as file name, submission date, and file status.

Effective Communication Channels: We established a communication system within the Claims module, which allowed issues to be logged and discussed in real-time. This incorporated a threaded comment system, much like a chat or email exchange, where documents could be attached for further clarification. This communication system was designed to be used by both ModMed and offshore staff to facilitate efficient problem-solving.

Customizable Tenant Settings: We included settings that allowed tenants to opt in or out of the Claims module and to select their preferred external processor. This customization ensured that the system could adapt to the unique needs of each tenant.

Bulk Load Capability: Recognizing the need for high-volume data processing, we equipped the system with the ability to bulk load log records, further increasing the system’s efficiency and usability.

Transforming medical billing efficiency with an innovative Claims Module

Technologies used

Yii Framework and LAMP stack (Linux, Apache, MySQL, PHP) for custom development 

Node.js for real-time functionality implementation 

Balsamiq for wireframes during the product discovery phase 

Graphic design, User Experience, and User Interface creation for optimal look and feel 

HTML, CSS, jQuery, and Responsive design for graphic design integrations 

Selenium IDE for browser automated testing 

Redmine as a project management and communication tool 

Jenkins for continuous integration and automated deployments 

Results

The Claims module is a testament to our ability to handle complex requirements and deliver a robust, secure, and user-friendly system that not only meets but exceeds our client’s expectations. The successful implementation of this module within ModMed’s platform reinforces our reputation as a reliable partner for software development projects in the healthcare sector:

These are only a few of the positive outcomes for Modernizing Medicine following the development of the Claims Module:

Improved Claim Management: The Claims module developed for ModMed improved the efficiency and effectiveness of their claim management process. This had a direct impact on their operations, making the entire claims process more streamlined and error-free.

Enhanced Data Security: With the introduction of secure file management and encryption, ModMed ensured the safety and privacy of sensitive data, adhering to the stringent requirements of the healthcare sector.

Improved User Experience: The introduction of an intuitive user interface led to increased productivity and user satisfaction. The ability to easily filter and find uploaded files have saved users valuable time and effort.

Customization and Flexibility: The customizable tenant settings and bulk load capability provided ModMed with flexibility, allowing the system to adapt to the unique needs of each tenant and handle high-volume data efficiently.