Client
A US-based Healthcare Organization
Challenges
Pharmacies in the US have to charge a patient’s insurance company (payer) for the prescriptions they fill. These charges are submitted for payment as prescription claims to payers. It would be extremely cumbersome for pharmacies to get these claims paid by individual payers. The payment process itself incurs some costs for the pharmacies,
which they look to minimize. Also, there are some business rules for these claims to qualify for payment. If claims fail some qualification criteria, they get rejected, and the cycle of payment extends due to corrections and resubmissions. Delays and mistakes can result in permanent rejection of a claim, causing a loss of revenue.
Solutions
Emorphis has developed a web based SaaS platform for customer, which helps pharmacies address the challenges mentioned. Pharmacies can subscribe to the client’s services which gives them an account in the SaaS platform. Through an intuitive web based interface, they can upload prescription claims, and the platform then manages the process of submission for payment.
Features
- Web based portal for pharmacies to upload their claims.
- Claim submission allowed in various formats like .csv, .xls.
- Sophisticated rules based validation engine for claims.
- Integration with Medispan for classifying claims as brand, generics, and also filling correct pricing information in the claim.
- Ability to submit claims through multiple switches and update their status in the system.
- Report of claims stating submitted / accepted / rejected.
Benefits
- Easy way for pharmacies to submit claims for processing.
- Early error detection leading to reduced rejections.
- Cost optimization by use of multiple switches.
- Easy status tracking of claims.
Tech stack
- C#
- .Net Core
- Amazon Aurora as the database
- Deployed in EC2
About Emorphis
Emorphis Technologies is a world-class software development and solutions company that truly believes in “Innovation in motion”. Delivery innovation on the go at an accelerated pace has been our success mantra to date. Over the years we have provided value to our clients in the field of enterprise mobility, cloud, IoT, backend development, Big Data Analytics, and Blockchain.
We serve industries ranging from unicorns, and startups to large multinationals in the healthcare, telecommunications, fintech, retail, and publishing industry. Our go-to-market software products – iStatement, iPublisher, and iBuggy have proved our metal with positive beneficial customer testimonials. We help our clients with successful product development, consulting services, and testing (manual & automated).
We have profound experience & expertise in various technologies like .Net, J2EE, PHP, iOS, Android, and Cloud Computing viz. Amazon Web services (AWS), Software QA & testing (Manual & Automation). Our designed products are cloud-ready and can be readily deployed on AWS/Azure cloud infrastructure.
Our pivot on engineering innovation and R&D helps quicken time-to-market, ensuring high quality at economies of scale, delivering cult competency for the global marketplace. We ensure that your ideas, concepts, and requirements are backed by brilliant execution at our end. Having said that we extend end-to-end ownership of product/application design, development, and deployment.
