Brightree is the fastest growing provider
of business management solutions in the Home Medical Equipment
(HME) and Durable Medical Equipment (DME) market. As Brightree’s
client base grew the need for an automated EDI solution became
evident. Brightree is the only software solution of its type
endorsed by the 2,200+ member VGM service organization.(www.brightree.com)
|
|
Productivity Challenge
Manually processing healthcare claims was time consuming.
Brightree’s EDI claims process was a manually intensive
process. An operator was required to login to each of the four
Medicare Durable Medical Equipment Regional Carriers (DMERC’s)
or an EDI clearinghouse to send or receive files for the insurance
provider. Because the DMERCs use asynch dial-up technology, the
process was time consuming and frequently required reconnects
to handle dropped connections. As their customer base increased,
the time required increased as well.
In addition, the challenge of “payor specific” edits
was continuing to grow as more and more payors became supported.
Each of these edits required a new release of the software to
generate the claim in the format required by the payor. Because
of these challenges, Brightree decided to find an automated solution
that could accommodate the submission requirements of the DMERCs
and provide a more timely solution to payor specific edits.
The Radley Solution
Hosted Healthcare EDI
Brightree made the decision to replace their manual system
with a hosted version of Radley Corporation’s B2B EDI solution,
iR*EDI. Brightree now has the ability to produce and verify EDI
and the capacity to automate all of the processes related to
EDI. With iR*EDI Mapper they also have the flexibility to produce
a standard document and allow iR*EDI to verify it.
In addition they can optionally add or change information that
is required for a specific carrier, without the need to hard
code the solution. Claims are now started from the Brightree
software application through a web service, and generated claims
are placed in the iR*EDI Scheduler for immediate transmission.
Upon completion, a process status is returned to Brightree along
with any applicable reports for that transmission. Receiving
of data is scheduled for every customer and automatically moves
the data and makes reports available to the Brightree customer.
Productivity Improvements
Brightree now has the ability to be flexible and connect
to different software platforms easily.
One of the most beneficial features of iR*EDI was the ability
to handle specific insurance carriers specifications in a mapping
situation rather than hard coding. They are also benefiting from
the automation of the DMERC’s dial-up async access. Now
the iR*EDI Scheduler automates the dialing and redialing capabilities
to the DMERCs. The added benefit of Radley’s Service Oriented
Architecture (SOA) will help Brightree respond more quickly and
cost-effectively to the changing market conditions. With the
SOA environment Brightree now has the ability to connect to many
different information systems, whichever platform or technology
it might have been developed on.
“Brightree is a progressive medical claims processing
software company. We are known in the industry for aggressively
leveraging technology to speed and automate business processes” notes
Brightrees IT Manager, Mike Durnwald, “The Radley partnership
has helped us meet our EDI goals by removing all of the manual
processes from our eCommerce processing. It has allowed us to
standardize our processes and produce faster claims, and in turn,
helped us better meet the needs of our clients.” |