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Case Study

Client:
The client is a USA based medical billing company that deals in toxicology labs.

Challenges:
Client wanted to automate the data exchange process with multiple labs via HL7 secured channels using Mirth Connect, increasing their revenue against manual data submissions.

Solution:
Taction designed and developed number of customized HL7 secured channels using Mirth Connect. Mirth Connect is a cross-platform HL7 interface engine that enables bi-directional HL7 messages between systems and applications over multiple transports. It automated the billing submission process with labs.

Technical Solution Overview:

• Labs compose and send transaction messages (DFT 03) in HL7 format to HL7 server that are received or fetched by HL7 server remotely
• HL7 server validates these messages for patient name, address, DOB, referring doctor, plan id etc. and performs corresponding crosswalk on each transaction of corresponding messages as per the CMS and Non-CMS code rules through custom build logic and Billing Company’s Database to obtain transformed DFT and ADT messages
• HL7 server then decides whether to send a transformed message or to put the raw message into suspense to process later or to reject the message permanently
• ADT and DFT messages are sent to corresponding destination
• Corresponding destination receives these transformed messages and processes further as part of the insurance claim process

Technology:
HL7, Mirth Connect

Outcome:
With the implementation of Mirth HL7 based customized channels, the tedious manual works of message submission, coding, validation, tracking etc. became easier and got to higher accuracy and speed. A basic level of regular maintenance efforts was enough in managing the Medical Billing Organization and Labs collaboration needs.

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