Digitising Claim Verification Process for Authentic4D: An American Health-tech Company

The Daffodil team had prior in-depth understanding of the insurance claims lifecycle and knew that Authentic4D needed ways to increase the efficiency of claims verification. The team analyzed the project requirements, and created an end-to-end development plan that would facilitate faster claims verification in a digitized workflow. The web application was created with PHP using the Laravel framework. The front-end development involved building user interfaces with React and dynamic elements enabled through DHTML. 

The entire system, built on an underlying microservices architecture, consists of provisions for an admin from an onboarded healthcare organization or radiologist group to create user roles such as hospital staff, facility staff, concierge, radiologists etc. Each user role has certain access privileges and completely distinct user-friendly views of the web application. Radiologists who are board-certified in the same state as an insurance claimant can verify the veracity of the claimants’ radiology reports. These reports consisting of diagnostic images can be viewed and managed on the application. Following a positive verification, a billings cycle report is generated that can be sent to the insurance provider for reimbursement. The major advantages of the web-application are the following:

Verification Of Diagnostic Images

Once the hospital staff creates an insurance claimant’s case with all their details, their diagnostic images such as MRIs, CT scans, etc. are uploaded onto the system. Third-party HTML5 DICOM Viewers have been integrated with the system, making the diagnoses, viewing, archiving, and transmitting of medical images seamless and compliant with HIPAA file security standards. The viewer allows radiologists to search for required diagnostic images quickly, while the images are protected from any form of misuse or malpractices.

Reduced Claim Cycle Time

During the manual processing phase, Authentic4D faced the issue of aligning claims cases to the availability of radiologists. A radiologist who was assigned a case may not have verified it right away as they may have been busy with other tasks. To resolve this, radiologists can now turn their jobs queue on or off. This allows the Admin to assign cases to radiologists who could take up the verification task on priority, thereby reducing the claims settlement time.

Leveraging Cloud Storage

Each thin-slice MRI image of an insurance claimant could consist of hundreds of megabytes of data. Due to the strict retention policies under HIPAA storage on physical devices could be costly. The Amazon S3 data-storage services employed by us provide a pay-as-you-go data storage and pricing model. Storage can easily be expanded or reduced as per the customer’s changing requirements. The AWS cloud is also used for assigning individual security credentials and multi-factor authentication to control which operations each user can perform.

Compliance, Transparency, And Security

The Daffodil team has made sure that Authentic4D’s web application is HIPAA compliant, maintaining the confidentiality, integrity, and availability of electronic-Protected Health Information (ePHI). There is end-to-end encryption to protect the patients’ diagnostic reports during transmission. PostgreSQL manager with a built-in data encryption feature is used for the encryption of backups, the claims databases as well as logs. Additionally, there is proper cognizance of the healthcare institutions’ policies and patients’ consent before the use of their data on the web application so that proper transparency is maintained.