Insurance, Transportation and Language Services

Challenge

The patron is a foremost USA-based establishment of Transportation and Language (translation) services functioning in many countries. Our partners hope to create web applications that offer complete services to many companies, whose main goal is to create centralized business software that can access all levels of business. This includes the home operations of the insurance company (payer), injured workers (patients), equipment suppliers, and facility providers.

Critical challenges faced by the client

• Process suitability (claim) files of diverse file formats (Flat file, spreadsheet, EDI) extracted from various Payors from BizTalk
• Single interface to accomplish Payor, users like agents, providers and their subsequent details, services, and billing information and instructions
• Referral (appointment) edge to accomplish all details of transportation/translation service on a single platform
• Devoted queues to work on for different teams like Service, Processes, Quality, Billing
• Maximum automation structures to increase efficiency, quality and decrease human errors in areas such as Operations and billing
• Complete UI and automated report generation using graphs/diagrams for easy data management

Expertise

Tools & Technology

• .NET
• .NET core
• Asp.NET MVC
• JavaScript
• React
• Biztalk
• jQuery
• C#
• Microsoft SQL server
• Microsoft Graph API
• CSS
• bootstrap
• Telerik controls and reports
• Twilio
• Lyft
• Google API

Solution

Considering the necessities of the patron, Shivagya Infosoft’s website Application development team formed a web-based solution using C# and React that supports numerous backend services and manages all internal and external processes of the patron.

Procured are some of the required features provided by Shivagya Infosoft’s website application:

• Unified interface to manage numerous entity information such as Payors, users, third-party providers, and their complex details, state/county wise pricing, service number, billing cycle details, and more.
• Delivers BizTalk EDI solutions to download claim particulars from the Payor’s network, import into database, and interface to display claim details related with Injured Worker (IW).
• A sole platform to negotiate the appointment life- cycle from layout, armistice to final getting of payment from the Payor.
• This interface specifically manages Transport services like Ambulatory services, Wheelchair, Air ambulance, and Transformation services like Onsite (regular, certified, legal), conference call specific details
• Shivagya Infosoft implemented a number of the automation process that enhanced efficiency and reduced human dependency

Solution Benefits

• Robotic mileage calculation (Google APIs) based on destination and travel time.
• Robotic cost-effective resolution to booking the ride from Lyft, Uber, and other local service providers.
• Robotic communications at different stages of the appointment by generic email templates
• Diverse task queue interfaces devoted to a team like an intake, service, care, operations, billing, etc. to work on and clever task assignment rules
• Interactive voice response (IVR), dial/receive calls over browser to reduce hardware dependence and create dynamic call routing
• Automatic Calls/SMS/Fax using Twilio with IW for various purposes like validation/reschedule an appointment, talk to representatives, surveys, etc.
• Interface to load emails on-screen by office 365 Graph APIs and associated actions
• Robotic invoice generation in various formats like PDF, spreadsheet, XML, tab-based txt, etc., Auto reconciliation and Auto follow-up process
• Subsequent US health standards to generate EDI 837, 277, 999 files through BizTalk
• System generated management reports to review quality, efficiency, sales, services, accounting in real-time
• Devoted provider portal where they can log-in and review services assigned to them, accept incomplete or assigned tasks, payment check status, submit queries, etc

Result

With Shivagya Infosoft’s website-based Application Solution, the patron was now able to streamline and participate in the complete inbound services, operations, billing, and sales procedures on a sole software. The patron could systematize the billing process, reduce physical efforts, minimalize hardware and work location requirements through digitalization. Shivagya Infosoft’s digital solution accessible numerous features such as web-based calling which enhanced response time and resulted in quicker resolution of consumer queries.

The patron will no longer have to switch back and forth between numerous software and hardware like outlook, phone systems, and the sure-shot credit goes to our cutting-edge state-of-the-art solution that brings everything on a single platform. The patron’s business is now able to increase per day referral process and output drastically by switching to robotic call answering, robotic follow-ups, robotic ride-booking systems, and all are done on a centralized platform.