Gyan Web Solutions | Healthcare
Healthcare

Claims Processing

Our solutions offer the right expertise in the healthcare claims processing industry. Our technology domain knowledge on workflow systems that decrease electronic claims receipt and pre-processing cost, reduce phone calls from providers and improves your auto-adjudication rate. Gyan Web Solutions offers a combined expertise to a host of integrated imaging and data capture solutions that support a unified payment stream. We're the only provider of both industry-leading software automation and business process outsourcing solutions.

Need your claims processing systems to get more efficient?

  • Claims processing is both the single largest business cost and one of the most visible customer experiences and improving the claims processing experience helps companies achieve a new level of sustained operational efficiency resulting in overall customer satisfaction
  • One of the most vexing problems for any clinical practice, outpatient care facility, or hospital is processing claims quickly, efficiently, and correctly the first time
  • Gyan brings years of experience in claims management and claims adjudication to each project to significantly increase the cash flow efficiency of a practice or facility

Project Case Study 1: Gyan Web Solutions has extended one of our existing customer's Claims management system to support the requirements of the application which includes Auto-process, Auto-approve PPO claims including Claim Verification, Invalid Procedures Codes, Provider Verification, Fee Schedule verification, Date of Service verification, Duplicate Service verification, Incomplete Treatment plan, Member benefit queue limit, and Potential Coordination of benefits (COB)

Project Case Study 2: Gyan’s client was about to bring on a new program specifically designed for one payer organization.  The payer required certain modifications to the information provided in a standard 837 file format.  Gyan Web Solutions designed and built a claims management system that handled every aspect from claim intake, to creating the modified 837, transmitting the 837 to the payer, and receiving the 835 file back into the system.  Extensive reporting allowed for our client to monitor activity and flag exceptions that had to be manually processed. 

 


Provider

Create EMR for specialty healthcare providers. As examples, provider for catastrophic brain injuries; provider for methadone treatment centers. Capture medical records. Customized clinician notes fields and work flows. Work to HIPAA security standards, HL7 data, ONC certification standards.

Create EMR Systems for specialty healthcare providers

  • Most organizations use one of the major off the shelf EMR systems, Epic, Allscripts, Cernan, or any of a number of established companies.  But specialty or niche practices often cannot have their specific requirements met by off the shelf systems. 
  • Gyan Web Solutions has worked with specialty practices, such as catastrophic brain injury, drug rehabilitation, or plastic surgery to build highly functional EMR/EHR systems that meet not only the general needs of any practice, but also the specific needs of specialty and sub-specialty practices. 
  • Medical practices cannot change their methods of operation and record keeping matching a software package.  It is therefore essential that the software package meets the specialized needs of niche practices.

Project Case Study 1: Gyan Web Solutions has worked with a Texas based company with multiple specialty rehabilitation centers to evaluate their existing processes and software that was used to track patient on-boarding, clinician notes, progress of the patient, and follow up upon discharge.  The evaluation confirmed the company's initial impression that an off the shelf EMR system would not meet its needs.  Gyan constructed an all-encompassing EMR to include the specialty requirements including extensive and detailed reporting requirements in order to get prompt reimbursement for services.

Project Case Study 2: Gyan Web Solutions has also worked with a company that is the leading provider of clinical software, connectivity, and information solutions for more than 20,000 physicians across the US. Their Practice Management System, a product suite that has extensive features to streamline patient information management and enables practice-wide clinical workflow automation. The key challenge was to achieve windows look and feel on a web-based application with a similar level of performance.

 


Wellness & Disease Management

Increased automation rate for claims adjudication. Reduced need for human intervention to less than 10% of claims, saving millions of dollars per year in labor costs. 

  • Wellness is generally used to mean a healthy balance of the mind, body and spirit that results in an overall feeling of well-being. The term has been defined as an active process of becoming aware of and making choices toward a more successful existence
  • Gyan Web Solutions has created Wellness portals that allow the creation and management of Wellness programs such as smoking cessation, weight loss, healthy eating, exercise regimens, etc.  The portal allows individuals to set goals and track their progress toward meeting the goals.

Case Study 1: Gyan worked with a leading Research and Education and a not-for-profit health care organization to provide a user-friendly interface to facilitate the Health Risk and Wellness Assessments online and maintain the Electronic Clinical Decision Support (eCDS) system designed to bridge the gap between clinical knowledge, clinical systems, and clinical workflow. The functional objectives of the project included improving clinical performance by automating risk profiling, patient focused care planning and streamlined workflow; To provide critical best-practice clinical information to doctors, healthcare professionals and patients for decision support at the moment of care enable the systematic delivery of individual programs of care.

Disease Management :

  • Better patient outcomes are the concern of payers, clinicians, and patients.  By tracking the prescribed drug and behavioral program, all involved parties can work together to ensure a higher level of patient compliance, and a lower incidence of ER visits and hospitalizations.  Patients are healthier and happier, care costs are controlled.

Case Study 1: Gyan Web Solutions developed a new generation portal to allow access to appropriate information for each participant, including alerts to clinicians when patients were not complying with the treatment protocol.  It provided an easier way to coordinate the activities of patient, clinician and payer. Examples include notification if a prescription is not filled on time, and missed doctor appointments. Alerts were built into the system so that a clinician can intervene before the health of the patient is adversely affected. 

 


Pharmacy Benefit Solutions

Our solutions combine a wide range of PBM software applications, Application Service Provider (ASP) processing services designed for many of the large organizations such as pharmacy benefit managers, managed care organizations, self-insured employer groups, retail pharmacy chains.

Our clients have gained increased control of their pharmacy benefit dollars and maximized cost control and quality of care through a full range of pharmacy spend management services.

Built Systems to process hundreds of thousands of claims per month

  • Management of prescription drugs has evolved since the late 70s as a line of business whose costs accounted for 10% ($2.6 trillion) of US Healthcare spending .PBMs will save the healthcare system an estimated $2 trillion through 2021
  • Gyan Web Solutions has been working within the PBM space for over a decade building transaction processing systems, interfacing with every major insurance carrier, designing and building inventory control systems for specialty programs such as the Federal 340B prescription drug program
  • Gyan's PBM solutions are safe, secure, standards compliant real time high volume transaction oriented and designed for organizations such as pharmacy benefit managers, managed care organizations, self-insured employer groups and retail pharmacy chains
  • Gyan's clients have gained increased control of their pharmacy benefit dollars and maximized cost control and quality of care through a full range of pharmacy spend management services

Project Case Study 1: Gyan Web Solutions has worked with a leading PBM provider to build a Virtual Inventory System that supports 340B program that is approved by US Federal Department to provide discounted drugs to various Qualified Health Centers in the US. The program combines traditional Prescription Benefit Management with the power of technology to allow health centers to track eligibility, manage inventory and ultimately provide greater access to prescriptions for patients.

Project Case Study 2: Gyan Web Solutions has developed a web based healthcare portal for a PBM vendor that caters to providing online medical assistance  and an online drug pharmacy that ships drugs and supplements orders, when the customers provide their health information to the Vendor's approved Physicians.