Brandon Sharp

A medical bill adjudication software application designed to reprice group health, workers’ compensation, and auto liability medical claims. Allows for EDI, FTP bill drop, web service, and traditional keying of medical claims for entry into the application database. Once bills are entered, state rule methodology is applied in addition to PPO discounts. Finally, an explanation of benefits form is generated to complete the adjudication process.

Features Include:

• Complex state discount logic and rules engine
• Complete bill adjudication and claims tracking application
• EDI/web service support
• Extensive reporting capabilities
• Thin-client access

Technologies Utilized:

• C#
• Oracle
• MS Terminal Services
• ActiveX
• Crystal Reports

Budget:

• $600,000

Project Length:

• 2 years