Case Studies

Claims Management

Our client, a healthcare provider based in the USA, was facing significant challenges in handling the overwhelming amount of paperwork and manual processing of insurance claims. They were struggling to keep up with the claims processing requirements and payments. To overcome these challenges, they approached us to develop an automated solution for their claim submission and payment processing.

A family under an umbrella with some medical icons

Client requirements

The client wanted us to create a system that would automate their claim submission process and help them manage their insurance payments more efficiently. The system was also required to have an eligibility checker application that would help them determine the insurance coverage and ensure that the claims were submitted to the correct insurance company.


We developed a system that could create claims in EDI 837 format using data from the client's database. This format was widely accepted by insurance companies, which made it easier for the client to submit the claims without any manual intervention. Once the insurance companies processed the claims, they would send the payment information in the EDI 835 format. We integrated this information into the client's database to update the status of the claims, ensuring that the client had an accurate picture of what claims had been paid.

Additionally, we developed an eligibility checker application that utilized EDI 270 and 271 files to determine the patient's insurance coverage. This application helped the client ensure that they were submitting claims to the correct insurance company and reducing the likelihood of claim rejections.

The system was designed with a user-friendly interface, making it easy for the client to access and manage all the claims and payment information in one place. We also provided the client with ongoing support to ensure that any issues that arose were addressed promptly.


The solution we developed for our healthcare client helped them to automate their claim submission process and insurance payment processing. The client no longer had to rely on manual processes, which reduced the likelihood of errors and ensured that claims were processed efficiently. The eligibility checker application also helped the client to ensure that they were submitting claims to the correct insurance company, reducing the likelihood of claim rejections.

Our solution helped the client save time and money, and they were able to focus on providing quality healthcare services to their patients. The client was delighted with the system we developed, and we continue to work with them to provide ongoing support and maintenance.

Key Highlights from the Topic

Automated Claim Submission

  • EDI 837 format
  • No manual intervention

Payment Processing

  • EDI 835 format
  • Updated status of claims

Eligibility Checker Application

  • Utilizes EDI 270 and 271 files
  • Ensures correct insurance coverage

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