VerifiaBill
Insurance Auditing and Consolidated Insurance Billing Software.
eNest helps Beneration, LLC to design, develop and launch a SaaS model software based on their requirements.
As affirmed by the Medical Billing Advocates of America, 8 out of 10 medical bills contain errors that cost insurance companies and patients money. Billing audits are one strategy to fix this problem. Billing Audit is an organized process which inspects and evaluates the effectiveness and reliability of clinical documentation and medical billing data submitted to the payers. Data sources to conduct billing audits consist of Clinical, Financial and Policy related documents.

Audits can be conducted either the before claims are sent out to the payers (prospective) or after the fact (retrospective). Billing Audits are a lot more extensive in degree than Coding Audits and cover all the claim submission process areas, medical billing life cycle starting from insurance verification processes, follow-up processes, payment posting process, and denial management process.

Billing audit is a complex task where many things can go wrong. It takes a seamless, highly efficient system to conduct medical claims processing without critical errors. Even minor mistakes can spell trouble for healthcare providers, insurance companies, and patients. Billing audits may sometimes appear to be a luxury, especially in a very bustling practice; however, there are various convincing reasons why performing audits is beneficial. Those benefits cover clinical practice as well as administration.

Billing audits may in some cases appear to be an extravagance, uniquely in a bustling practice. However, there are various convincing reasons why performing reviews is helpful.

As billing becomes more complex, a deliberate and strategic approach to billing audits will be necessary for every employer. Establishing best practices for your audit processes will help ensure that your measures get the most out of the time put in your audit efforts.

eNest Development Team

About VerifiaBill

At Beneration, we have more than ten years of experience streamlining and auditing group insurance invoices—we’ve been considering the employee benefits industry for significantly more. In 2016 we utilized this expertise to build up a completely new programming software from scratch—VerifiaBill.

VerifiaBill’s proprietary software offers Premium invoice auditing services and Invoice consolidation and reporting. We built VerifiaBill with our customers in mind, addressing all of their unique needs for managing employee benefits and insurance coverage.

Client Profile

Vishnu Enjapoori, Director of Enterprise Applications @ Archetype Solutions Groupis a specialist in developing solutions to challenges for ideas to address needs within their companies and industries. Vishnu has an idea for developing an insurance niche solution that provides insurance invoice auditing and consolidation service.

Client Requirement

This project’s main objective is to help the insurance company eliminate carrier invoice errors and properly allocate benefit costs amongst all of the unique employee cost centres.

It is nearly impossible to fully audit carrier invoice by a company because of all the employees, adjustments, divisions and codes on the invoices. Therefore, they came up with an idea to provide this online service to audit the data.

Business Situation

Manual insurance invoice auditing needs additional, internal auditing too. Traditional auditing by workers is simply unrealistic with the volume of today’s insurance carriers. Moreover, a single approach to auditing countless invoices increases the risk of errors in the process.

Group insurance carrier invoices can be extremely complicated and may contain inaccuracies in billing. While some billing practices can help eliminate billing inaccuracies, Verifiabill invoice auditing software is the best way to ensure invoices are fully reviewed and tracked for accuracy.

Verifiabill can help you save your time and money by transforming your carrier invoices into data insights that accounting and HR will love. Verifiabill will also simplify invoice consolidation. Verifiabill also integrated with multiple benefits administration providers for seamless data sharing.

Why VerifiaBill?

VerifiaBill is a web-based system which helps employers to manage their healthcare costs. It offers insurance invoice auditing and consolidation. VerifiaBill’s auditing and payment technology help employers to save money immediately and in the long run.

VerifiaBill’s objective is to ensure that your employees have the exact coverage that they signed up for, your company pays exactly what is owed. Your insurance invoices can provide useful data insights.

Features Offered

Authentication and Authorization: With the help of this module, we allowed the authorized user to access the portal, and grant/restrict them access to specific features/ data of the system.

Invoice Consolidation: Through this module, employers can import all of their insurance invoices and view them in one consolidated package. This was achieved by processing the XML files, creating CSVs, and saving the data to a database (BenAdmin Data Receiver).

Carrier CSV Job Management: Verifiabill obtains different carrier data on the different format of PDF, CSV, etc. on a different way of uploading via UI or directly received from the Carrier system. This module was designed to automate the entire life cycle of saving the data into the database, parsing the CSV files, initiating the name resolution process, and creating a discrepancy record.

Name Mismatch Resolution: This is a process of matching names between carrier data and BenAdmin data that we received in CSV’s form. There are two categories in which the process differentiates names mismatches:

  • A) Potential Matches: These are matches matching the First Name, Last Name, Middle Name and Last four digits of SSN.
  • B) Manual Matches: Where we have slightly different names.

Invoice Audit: Through VerifiaBill’s automated audit engine, employers can easily identify any discrepancies between their benefits administration technology system of record and the charges their insurance carriers have recorded on invoices. Through this module, employers can also identify their source and ensure resolution.

Assured Payment: VerifiaBill collects your verified insurance premium cost and pays carriers on your behalf.

Cost Center: VerifiaBill analyze all your insurance premiums and attribute each line to a specified cost centre.

Key Milestones

Millstone #1
eNest brainstorm the complex requirements of the product with Vishnu Enjapoori and come up with a technical setup of the product
Millstone #2
eNest developed a console application to process the PGP/CSV files and store into the database using XML mapping file
Millstone #3
eNest developed a frontend UI and integration with backend API
Millstone #4
eNest continuously adding/ updating the features to make the better user experience

Challenges

  • Authenticate and authorize the different carriers to submit their carrier data
    • Authentication is done using JSON web token-based authentication to authenticate the angular app. The system is designed to send the token to authenticate every request after the user logged into the system.
    • Authorization is done using the default authorization of ASP Net-zero template, and it is done by the attribute named AbpAuthorize. If we decorate the app service/web controllers with AbpAuthorize attribute and authorization, the framework will be done.
  • Create a generic data receiver that maps data from PGP/CSV files to a database using XML mapping files.
  • For the Naming resolution, we created a background worker that processes one job at a time called “ImportJobManager.cs”.
  • ImportJobManager processes the job in the background and will run after 2 seconds. It will parse the CSV in a specific format, name resolution, and discrepancy record creation automatically.

eNest Team

Location: Mohali, Punjab
Partnership Period: June-2016 to August-2018
Team Size: 5
Team Location: Mohali, Punjab

Services

Product Development and Testing

Technologies

Front end technologies: Angular 4, TypeScript, Node.js, Bootstrap 3, HTML 5, CSS3, JQuery

Backend: Asp.Net Boilerplate template, Asp.Net Core 1.0, C#, SQL Server 2014, Azure App Service (For Deployment), Dapper, Entity Framework ORM 6.1.3, Dapper repository pattern

Third party Integration: Google chart

Unique: Generic XML reporting, Multitenant website

Things Learned

SignalR, AspNet BoilerPlate, ItextSharp, Castle Windsor, TypeScript 2.3, Asp.Net Core, Dapper ORM, CSVHelper

Key Customer Value


    • Save time and focus on other activities.

 

    • Ensure that their employees have the exact coverage that they signed up for and their company is paying exactly what they owe.

 

    • Making sure claims are submitted correctly.

 

    • Protecting against fraudulent billing activity and claims.

 

    • Reducing and even preventing incorrect payments.

 

    • Ensuring claims are submitted accurately,improving the relationship between you and your payers.

 

    • Decreasing the chance of an external audit.

 

  • Get useful data insights from carrier invoice data .

Tags

Project Team (L to R): Kamal Singh, Param Singh, Jagdeep Chawla

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