Client Challenge:

  • AS400 resource unavailability: The client had their application built on AS400 and was facing challenges in making any changes to the system. With a scarcity of dependable RPG resources, they had a long-overdue migration planned.
  • Clearing claims’ backlog: They wanted to clear the pending claims that were mistakenly sent to the wrong payer, which was against a recently announced industry regulation.
  • Automating claims management: They wanted to replace the manual checking and submission of claims with a solution that automatically validates and sends those to the respective payers. Understanding claims accuracy was difficult and hence there was no track of the reasons for claim rejections.

These concerns motivated the client towards a complete re-write of the application on a newer platform.

Solution

Nalashaa’s extensive AS400 & healthcare billing expertise enabled the team to do it right the first time and resulted in delivery of the first release in just 5 months. Our technical team worked in conjunction with the client team during the first month for KT and documenting the AS400 application, post which we independently managed the project.

  • For accuracy, the team created rules-engine toautomatically read remittance for 835s, post which the 837 is pulled, edited accordingly, and re-submitted. Re-submission of the old claims was done based on the explanation of benefits.
  • Post the re-submission of the queued claims, the new system was planned and the choice of platform was .Net. Nalashaa engaged an SME to chalk out a migration plan for data, processes, and added features like analytics/reports as per requirements, with an ongoing support & maintenance engagement.
  • Once the plan was approved, the next 4 months of development were characterized by frequent demos, staff training, and change management implementation.
  • The patient eligibility and authorization check processes were automated with Robotic Process Automation technology. The bots now check and verify the claim details before sending them to the right payer, improving the accuracy.

We also built KPIs to monitor the internal performance, and validators to check the accuracy of submissions and receivables. The automations & dashboards helped minimize denials and improve receivables.

Technology Stack

  • AS400
  • DB2
  • .Net
  • MySql
  • Azure
  • Angular

How to start the journey?

To choose the right AS400 support for your business, we would like to understand your needs better. The form below is a great way to start that!