Healthcare Billing Automation Using HL7 and Mirth Connect

Billing is the lifeblood of any healthcare organization. Collecting money for services rendered enables your organization to cover operating costs and improve the patient care services.

Client:

One of the Top 100 USA based medical billing companies provides fully integrated medical billing services for physicians.

Challenges:

hl7 automation

The medical billing process usually starts at the initial point of contact between a patient and a healthcare organization.

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.
● 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.

Technology:

  1. HL7: The data standards allow healthcare organizations to share clinical information easily. Because of the ability to exchange information, it reduces the tendency for a healthcare organization to be highly variable and geographical isolated.
  2. Mirth Connect: This cross-platform engine interface is used for enabling the information’s management by sending a different kind of messages with bi-directional sending. This engine interface is primarily used in Healthcare or Medical care organizations. Mirth was one of the tools selected for testing future interoperability tests. 

Outcome:

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.

 

    • Categories: HEALTHCARE