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Health Insurance Software to Streamline Injury Management and Recovery

Health Insurance Software to Streamline Injury Management and Recovery

Industry
Healthcare, Insurance, Professional Services, BFSI

Customer

A US company offering caregivers and patients the services related to vehicle accidents, such as handling evaluations for injured patients by licensed health professionals and assisting in referring patients to specialty care physicians in compliance with their health plan.

Challenge

In any injury case, managing the process of treatment and recovery of damages is the troublesome and lengthy process, requiring seamless cooperation of multiple parties on every step of the way, from claim’s registration by caregiver or law firm to billing. The Customer was looking for a system to facilitate and streamline the process. At the first stage of the project, the Customer turned to ScienceSoft for a system concept and detailed requirements specification.

Solution

The concept created by our team of Business Analysts includes three types of system users: caregivers, law firms and medical finance companies. The solution itself allows to streamline the cooperation between three parties and circumvent the process delay.

How the system works

Within the system concept, each party will be able to track the case progress and update the information on injuries, treatment, medical bills and claims.

While caregivers will create treatment plans and monitor patient recovery, they will have access to the related system functionality, including patient personal information, insurance information, lab results and injury photos. Law firms, in turn, advise the injured parties on legal issues, assist in insurance coverage and ensure the appropriate compensation for injuries. Therefore, the legal party will access the functionality focused on bills, claims and documentation. Medical finance companies will access the features related to case processing and claim creation.

By allowing transparency of processes between the parties, the solution serves as a tool to facilitate and improve communication, organize workflows and cut on time for case settlement.

Results

The system concept along with requirements specification created by ScienceSoft’s Business Analysts, allows the Customer to provide caregivers, law firms and medical finance companies with a cooperation solution to seamlessly handle vehicle accident injury cases. Currently, our team is defining the architecture and stack of technologies to start implementing the system.

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