Case Study

Automated Benefit Verification and Treatment Cost Estimation

How a healthcare technology company enabled dental care providers to deliver the most accurate treatment plans to their patients.

A leading health tech company automated the insurance verification and treatment cost estimation process in their offering for dental care providers, using an integrated API solution.
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Industry & Region: Healthcare, US
Technology Stack:
Serverless Container Orchestration: AWS Fargate, API Management: APIGEE, Message Queuing: RabbitMQ, Runtime: .NET Core, RDBMS: PostgreSQL, Distributed Services & Communication: gRPC
Client Overview
Our client is a rapidly growing healthcare technology company dedicated to revolutionizing healthcare practices across the United States. They provide innovative technology solutions to care providers, aiming to enhance their operations and care delivery.
Business Challenge
A major portion of our client’s customer base is from the dental care provider segment. Our client observed significant challenges faced by dental practices in managing patient insurance complexities. Manual processes for verifying eligibility and benefits were not only time-consuming but also prone to errors. This led to inaccurate cost estimates, resulting in surprise out-of-pocket expenses and eroding patient trust and satisfaction. Also, the lack of transparency around insurance coverage caused confusion and anxiety for patients.
Operational hurdles also plagued dental care providers. A lot of claim denials arose due to inaccurate information, causing a loss of revenue and administrative headaches. The staff usually had to spend valuable time manually handling eligibility inquiries and claim submissions, reducing their focus on patient care. This inefficient process led to frustration and burnout among staff members.
All these challenges hindered dental practices’ ability to deliver seamless patient experiences and optimize operational efficiencies. Our client was looking to build a solution that would help dental practices navigate insurance complexities and streamline their administrative processes.
Solution Offered
After studying the client’s problems carefully, our experts chalked out a comprehensive solution to address the administrative burdens and claims processing difficulties of dental care providers (who are our client’s customers). We developed an integrated API platform tailored specifically for dental care providers, to suit their unique business needs. The solution leverages advanced algorithms and real-time data integration to deliver accurate treatment cost estimates and insurance benefit verifications instantly. Our solution seamlessly integrated with the client’s existing tool for practice management, empowering them with:
  • Instantaneous Eligibility Verification: With a single click, dental staff could verify patient insurance coverage and plan details at the point of care, ensuring accurate treatment planning and cost estimations.
  • Automated Rules-based Estimates: Our API solution, covering over 700 major payers in the US, generated instant, personalized treatment cost estimates, factoring in patient insurance coverage, deductibles, and out-of-pocket expenses.
  • Streamlined Claim Submissions: Electronic pre-determinations and claims with accurate beneficiary information minimized claims denials and maximized reimbursements.
  • Enhanced Patient Engagement: With real-time benefit information, our solution enabled proactive patient communication and engagement. Patients could make informed decisions about their treatment plans, leading to improved satisfaction and trust.
Value Delivered
  • Reduced overhead costs.
  • Optimized collections with reduced claim denials or write-offs.
  • Improved patient engagement and satisfaction.
  • Enhanced staff productivity with an intelligent and dynamic solution.
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Automated Benefit Verification and Treatment Cost Estimation