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 helps organizations create software solutions that combine modern technology with practical business needs. Our expertise spans enterprise software development, product engineering, AI, cloud, Salesforce, mobile applications, and DevOps, supporting organizations through different stages of their digital journey.
As an enterprise software development company, we develop scalable solutions that help businesses manage complex processes and support future expansion. Through AI software development, we help organizations integrate intelligent automation, develop AI-enabled applications, and improve the functionality of their digital platforms.
Our technology expertise also serves healthcare and fintech organizations looking for modern and connected software solutions. We help develop applications that support specialized workflows while focusing on scalability, security, integration, and the evolving needs of digital businesses.
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