TAPL | Techxotica Analytics Pvt. Ltd.

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Claim Management Platform

Problem

A Healthcare Insurance organisation's required system to capture, store and process the information from the Healthcare claim forms such as HCFA (profession claims), UB (institutional claims) forms.

Solution

A web based application was developed to easily and effectively capture the data from the claims.
A Data validations rules are implemented in the application as per the client needs. to validate the captured data.
A rule configurator is provided to the clients to update the Data Validation rules as per there new requirement.
A claim Auditing are implemented to maintain/protect the captured claim information.
Various formats of reports are provided for analysis and reporting.

Claim Data Extraction Platform

Problem

In spite of having an application to capture the claims data,there were still a large quantity of claims pending of processing, so an Automated Data extraction Service was needed to extract the large amount of pending claims.

Solution

A service was Develop to Extract the Claims Data Automatically without human intervention using OCR (object character recognition) technology.
We Have used an open source OCR engine named Tesseract OCR engine to Reduce the Cost.
An automated rules where placed to increase the accuracy and correction of the captured data.

EDI Parser and Generator Service

Problem

Healthcare Insurance companies receive/exchange the data in various formats, so a system was needed to Handle different formats of Data such as EDI (electronic data interchange) Files.

Solution

An EDI Parser service is developed to parse the various different types of EDI files (834, 837, 999, etc..)
An EDI Generator service is developed to generate the EDI files From the Captured Data of claims.

Letter Generation Service

Problem

If the claim gets rejected then insurance company has to inform about the status to the provider/patient, But preparing large number of letter manually was a cumbersome task,So a claim rejection letter generator system was required to generate the letters for rejected claims.

Solution

A Rejection letter generator application was developed to generate the rejection letter.
A template based Letter are generated as per the client requirement.

Health Insurance Claims

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Claim Management Platform

Claim Data Extraction Platform

EDI Parser and Generator Service

Letter Generation Service

Overall Benefits (ROI)