Hospital Billing & Insurance Claims Automation System
An intelligent billing and insurance claims automation system for MedCare Hospital Group's network of 6 hospitals. The platform automates patient bill generation, applies insurance policy rules, submits claims to TPAs electronically, and tracks claim statuses in real-time. Manual billing errors dropped by 89% after deployment.
The Challenge
MedCare Hospital Group was processing over 3,000 insurance claims per month manually, with a rejection rate of 18% due to coding errors, missing documents, and policy mismatches. Each rejected claim required 4-6 hours of staff time to investigate and resubmit, creating a significant operational burden and cash flow delays.
The billing team also struggled with inconsistent tariff application across six hospital locations, leading to billing disputes and compliance risks.
Our Solution
We developed a centralized billing automation platform using Laravel and React, integrated with the hospitals' existing HIS (Hospital Information System) via REST APIs. An OCR module automatically extracts data from scanned documents and populates claim forms. A rule engine applies the correct TPA policy codes, ICD-10 diagnosis codes, and procedure codes before submission.
RPA bots handle claim submission to major TPA portals and check status updates every 4 hours. Rejected claims are automatically flagged with the specific rejection reason and routed to the appropriate staff member for correction.
System Preview
Explore the key screens and dashboards we designed and developed.
Weekly Activity
Monthly Growth
Recent Activity Log
System Configuration
Measurable Outcomes
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