Contracts and reimbursement management system

1. The client is one of the oldest and largest health care services companies in the US.
One of its major business units provides software, services and consulting to
hospitals, physician offices, imaging centers, home healthcare agencies and payers.
The client wanted OFS to develop comprehensive contracts management software
to manage the entire contracting and reimbursement process. This software would
facilitate payment monitoring for better claim denial management and monitoring
for contract negotiation.
Business Benefits:
• Helped payers and providers handle complex contract terms and accurately
calculate expected reimbursements
• Helped maximize expected cash collections by tracking variance between actual
and expected reimbursement
Key Highlights
• Provided What-if analysis of contracts for better price
negotiation
• Maintained claim and history files to assist with contract
negotiation
• Helped denial and appeal analysis for reimbursement
discrepancies
• Helped determine and report variance and allowed users to
communicate effectively on their contract issues with payers
• Facilitated online claims submission
• Facilitated reimbursement process
• Helped in insurance claim submission through effective
workflow
• Helped update data in different patient accounting systems
Technologies
• VC++, Prolog, C#.NET, Windows server, MS-SQL server
Contracts and Reimbursement Management System