Patient-centric FHIR Models to Reduce Cost & Automate Processes

Implemented FHIR to improve efficiency in eligibility determination and claims management process

Client Background

The client is a leading RCM company with a client base of more than 150+ hospitals, physician-specialist groups, independent labs, radiology centers, and other providers

Home Case Studies Patient-centric FHIR Models to Reduce Cost & Automate Processes

Challenges

Improve the operational and financial efficiency of the eligibility determination application
Design a simplified and automated process for claims administration
Create an FHIR server for EHIR certification for the client’s PMS system to ensure secure data transfers in the format prescribed by HL7 FHIR

Solutions

Implemented the eligibility determination application by using the Eligibility Request and Eligibility Response resources
Configured the resources that informed the client about a patient’s eligibility during an episode of care and the cost incurred before the claim is made
The desired claims administration system was implemented using claim and claim response resources
Created FHIR Server for electronic transfer of data through secure APIs

Tools & Technologies

Microsoft .NET, Microsoft SQL Server, HL7 FHIR Foundation

Key benefits

Implementing FHIR saved the overall development and operational costs
Improved customer satisfaction
Increased the efficiency of the eligibility determination application
Tripled the processing capacity of claims
Client’s EHR got certified the first time