Unlike any other industry, the administrative functions in the healthcare ecosystem tie closely to the clinical aspect. The nature of the industry, regulations such as ICD10 and changing payment models such as VBP have only added to the complexity. Therefore, building and enhancement of these software solutions is trickier than it appears at the surface. At Nalashaa we have been helping ISVs build, enhance and maintain their solutions to keep up with the latest trends.
Development of solutions to enable scheduling, RTE/Batch Eligibility verification (270/271), billing, Claims management, Collections (POS, auto-posting), GL etc. Also, as these systems can’t function in isolation, integration with EHRs and medical clearinghouses is a given.
Claim processing and management
If there is one capability that can be termed the jugular of a medical practice, it would be claims management. An efficient solution allows for the admin staff to submit claims (837), track them (276/277), receive ERAs (835), reconcile those, do resubmissions and perform denial management from the same application. We have been helping ISVs develop systems that make this possible.
Development of solutions enabling submission of claims, analysis of Claims, denials, payables, receivables to help the providers understand their cash flows better and identify the areas of improvement to streamline revenues.