Commercial Health-Insurance Claims Processing

This project will modify our current system to enable processing commercial health-insurance claims. This will include the following components: 1. Verify insurance coverage 2. Identify for each claim the coverage amounts, co-pay requirements, data reporting requirements, etc. according to a table by insurance plan. 3. Expand data capture in our web system to include clinical data required by the insurer. 4. Develop a pipe with the insurer to pass to them clinical and financial information. 5. Develop a pipe with the insurer to receive from them payment information, denial information, etc. 6. Integrate processes for dealing with returned hearing aids and denied claims. 7. Build a process for posting payments to individual patient accounts and for reconciling payments. 8. Write various reports for use by our management. 9. (Optional) Automate the transfer of financial information from our web system to a QuickBooks database. Our system runs of a modified Drupal core consisting of approximately 50,000 lines of PHP code. Initially, this insurance processing functionality will be used with a single insurance carrier, Humana. However, we anticipate adding additional insurers over the next year.