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Custom Insurance Medical Case Management System Development

Client

Our client is a healthcare consulting company from the USA focused on helping insurance companies from Europe to adjust their claims.

Challenge

Some claims need to be checked manually by independent medical examiners who analyze electronic healthcare records to determine if procedures are medically necessary.

Solution

Our client decided to build a custom Claim Processing System to automate his intermediary business between insurance companies and medical examiners.

Process

The client showed us an out-of-the-box system that had been developed for them over three years by an outsourcing company. The code was written in PHP and based on not GDPR compliant architecture. An Independent GDPR Security Consultant recommended that our client redo the architecture and use not PHP, but only Java or .NET.

Using our GDPR checklist, we compiled the Software Architecture Document for a review by the same consultant. They approved our proposal for GDPR-ready system architecture and we started the development process.

Our Senior Java programmers started converting the PHP code to Java. In fact, it was backend development from scratch. We used the Spring Security framework to reduce development time while maintaining a high level of security: this is a powerful and highly customizable tool that provides the significant number of premade solutions for authentication, privileges management and encryption.

Given that the UI of the system was written in Reactjs and that we have Reactjs developers in our team, we did not rewrite Reactjs but modified it to meet new requirements. This allowed our client not to overpay. In addition, we appreciate that React.js supports quick writing of automated tests, which increases the security level.

On the client side, there was a Product Owner (PO), who had a thorough knowledge of system requirements, which allowed us to significantly reduce the development time.

We followed Agile/SCRUM principles.

  1. Our client took part in activities throughout the development process, including daily meetings, backlog refinement meetings, and planning meetings. If the PO requested certain changes to the product, they were taken into consideration and implementation during the next sprint planning meeting.
  2. Each sprint ended up in the DEMO meeting where the BelITSoft team presents the results of work to the Client.
  3. After the sprint is finished BelITSoft provides budget/financial reports to the Client. The reports are based on completed job/ activities performed within the sprint (usually 2 weeks).

On the client side, there was a Product Owner (PO), who had a thorough knowledge of system requirements, which allowed us to significantly reduce the development time.

Results

Our client received a full-fledged operating system that meets the requirements on time and on budget and began its active implementation in their business.

Three levels of users are registered in the system:

  • Insurance companies that send claims impersonalized according to the GDPR for review.
  • The system administrator is a medical professional. They receive a claim from the insurance company, decide which of the doctors to redirect it to as well as receive opinions from the doctors and check whether the reviewer performed the work properly.
  • Doctors who receive claims for review.

A claim is a form for collecting electronic healthcare records (gender, age, diagnosis, list of procedures and tests, appointments). Also, it is a tool to collect feedback from the examiner - whether the procedures and the rationale for them are assigned adequately.

This independent claims adjuster software has a built-in billing module that automatically calculates the cost of the claim review for the insurance company and for doctors based on the case contents and taking into account the price list. The cost difference goes to our client’s company.

Testimonials

Showcast

If you are looking for a true partnership Belitsoft company might be the best choice for you. They have proven to be most reliable, polite and professional. The team managed to adapt to changing requirements and to provide me with best solutions. I strongly recommend Belisoft.

Ivo Downes

Director at ShowCast Limited (Germany)

tichen

I expected and demanded a lot of you at Belitsoft company, but you exceeded my expectations. You acted pro-actively, challenged me at the right moments. Thanks!

Martin Beijer

CEO at Ticken B.V. (Netherlands)

EFI

We have been working for over 10 years and they have become our long-term technology partner. Any software development, programming, or design needs we have had, Belitsoft company has always been able to handle this for us.

Bjarne Mortensen

СEO at ElearningForce International (United States, Denmark)

Crimson

They use their knowledge and skills to program the product, and then completed a series of quality assurance tests. We were working in an agile way with them. Belitsoft performed very well throughout our project. We are definitely looking at Belitsoft as a long-term partner.

Eddie Nicholas

Service Delivery Director at Crimson (United Kingdom)

Berkeley

I highly recommend Belitsoft for website design and development. We were up against a tight deadline to launch the project. The work was delivered on time and within budget! I will continue working with Belitsoft as a valued partner for our web development!

Adrienne Herd

Program Administrator at UC Berkeley (United States)

Hathway

We have worked with Belitsoft team over the past few years on projects involving much customized programming work. They are knowledgeable and are able to complete tasks on schedule, meeting our technical requirements. We would recommend them to anyone who is in need of custom programming work.

Kevin M. Rice

Main Partner at Hathway Tech (United States)

Howcast

Belitsoft company is able to make changes instantly. One of our internal engineers has commented about how clean their code is. Belitsoft seems to know what they're doing, which I appreciate.

Darlene Liebman

Co-Founder at HOWCAST MEDIA (United States)

Fraunhofer

It was a great pleasure working with Belitsoft. Software Development Company. New requirements and adjustments were implemented fast and precisely. We can recommend Belitsoft and are looking forward to start a follow-up project.

Renè Reiners

Deputy Head of Division at Fraunhofer FIT (Germany)

Apollo Matrix

Belitsoft company has been able to provide senior developers with the skills to support back end, native mobile and web applications. We continue today to augment our existing staff with great developers from Belitsoft.

Pete Johnson

CEO at Apollo Matrix (United States)

Key2Know

Belitsoft company delivered dedicated development team for our products and technical specialists for our clients time to time custom development needs. We highly recommend that you use this company if you want the same benefits.

Bo Sejer Frandsen

Managing Director at Key2Know A/S in 2012 (Denmark)

Regen Med

We approached BelITsoft with a concept, and they were able to convert it into a multi-platform software solution. Their team members are skilled, agile and attached to their work, all of which paid dividends as our software grew in complexity.

Nicolas Tierney

COO at Regenerative Medicine LLC (United States)

Moblers

Having worked with Belitsoft as a service provider, I must say that I'm very pleased with the company's policy. Belitsoft guarantees first-class service through efficient management, great expertise, and a systematic approach to business.. I would strongly recommend Belitsoft's services to anyone wanting to get the right IT products in the right place at the right time.

Guy Doron

CEO at Moblers (Israel)

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