Healthcare Billing Automation Using HL7 and Mirth Connect
One of the Top 100 USA based medical billing companies provides fully integrated medical billing services for physicians.
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.
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.
● These messages 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 incorporated logic and Billing Company’s Database to obtain transformed DFT and ADT messages.
● Depending upon the step 3, HL7 server decides whether to send a particular 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 process further as part of the insurance claim process.
HL7, Mirth Connect
With the implementation of HL7 based customized channels, the tedious manual works of message submission, coding, validation, tracking etc. got to the next level of accuracy and speed. A basic level of regular maintenance efforts was enough in managing Billing Organization and Labs collaboration needs.