Practice Alternatives was able to improve its billing system and add more clarity to the billing process by integrating a DataDirect converter for EDI.
In this Success Story Spotlight, we look at Practice Alternatives, a company that provides the medical community with a certified EHR, expert billing services and practice management software. With DataDirect, Practice Alternatives customers were able to provide patients with more information about their insurance coverage.
With the healthcare industry becoming more patient-centric, many practices are doing everything they can to provide better experiences and greater transparency to their patients. Because of the disparity in costs and insurance coverage, as well as the complexity of billing codes and definitions, billing remains one of the most difficult areas. This can cause problems for both the patient and the clinic, since neither wants to be surprised with a hefty charge.
The existing Practice Alternatives solution provided a simple yes or no answer as to whether a procedure would be covered by the patient’s insurance. It was backed by a display from which a user could access more information, but was often presented limited, difficult-to-decipher messages. This resulted in some confusion as to whether patients’ insurance would cover the entire procedure, how much they had to pay and the reasoning behind it all.
Practice Alternatives then asked a third-party company for the full details, including copays, deductibles, out-of-pocket maximums, remaining amounts, and network information in order to get a better outcome, but the result was not an easy format to work with. The queries were answered in the form of a "X12 271" coded message, which is a healthcare eligibility/benefit protocol and transaction that gives information on insurance coverage. The format of these communications proved difficult to decipher—a typical 271 message contains around 97 different code types that must be converted into something understandable for consumers.
Rexpert, the Practice Alternatives billing system, was developed on the Progress OpenEdge application development platform by Great Valley Technologies, a long-time Progress Application Partner. After speaking with a Progress account manager about the problem, the account manager mentioned that DataDirect's EDI converters could handle X12 messages.
DataDirect converted the X12 string to JSON, allowing Practice Alternatives to incorporate the translated message within the HTML provided to the user, transforming numerical codes into thorough descriptions written in plain English and presented in a more user-friendly manner.
Clients have already recognized the advantages of this innovative approach. Practice Alternatives can now better serve their patients by offering more information about the billing process, allowing patients to control their healthcare with more freedom and flexibility.
In fact, by converting the codes, Practice Alternatives is able to generate a completely new revenue stream. Outside customers can now use a web service to convert their difficult-to-read X12 271 messages into an intuitive, beautiful results page with complete insurance facts.
Want to learn more about the capabilities and functions of DataDirect? Read the full case study to learn how Practice Alternatives used DataDirect to provide patients with more information about their insurance coverage.
Jessica Malakian is a product marketing specialist at Progress who focuses primarily on Progress OpenEdge. Jessica is a recent college graduate and is excited to begin her professional journey with Progress. Outside of work, Jessica loves reading and writing.
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