Development of An Automated Medical Claim Processing (AMCP) Prototype

开发自动化医疗索赔处理 (AMCP) 原型

• 批准号: 566196-2021
• 负责人: Sheikhzadeh, Mehdi
• 金额: $ 1.82万
• 依托单位: Lambton College of Applied Arts and Technology
• 依托单位国家: 加拿大
• 项目类别: Applied Research and Development Grants - Level 1
• 财政年份: 2021
• 资助国家: 加拿大
• 起止时间: 2021-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://www.nserc-crsng.gc.ca/ase-oro/Details-Detailles_eng.asp?id=724153
• 关键词: Development; Automated; Medical; Claim; Processing

For over 30 years, Dynamic Medical Services has been providing medical services for physicians and healthfacilities, including consulting, billing, technology, and training throughout Ontario. The company has alsodeveloped a number of specialized software applications, such as the Clearing House Model (CH) to facilitatethe needs of large clients that need to process a large number of complex medical claims and receive paymentfor these services. However, the current CH platform requires significant back-end manual intervention,processing, and delivery processes which could be improved through the implementation of available webservices and automation of some key processes.Although Dynamic Medical has significant experience and technical knowledge, they require technicalassistance to take advantage of current web and cloud-based technologies. In collaboration, Dynamic MedicalServices and Lambton College will focus on the design and development of a robust platform, utilizing the newand scalable technology stack to streamline the business workflow from intake to delivery through anautomated solution.The successful development and implementation of the final product will provide added benefit to DynamicMedical clients and enable the business to increase capacity. The improved process through automation ofmanual activities will result in saved time, improved accuracy due to reduced errors, and streamline thesubmission process of claims. The enhanced and simplified process will lead to market growth across Ontarioand inter-provincially. In turn, this will lead to the creation of additional jobs for technical and administrativestaff. Furthermore, this will also have a positive impact on primary care billers and hospitals, who will notlonger need to spend significant time following up on payment of services and with medical patients.

30多年来，Dynamic Medical Services一直为安大略省的医生和医疗机构提供医疗服务，包括咨询、账单、技术和培训。该公司还开发了许多专门的软件应用程序，如Clearing House Model(CH)，以满足大客户的需求，这些客户需要处理大量复杂的医疗索赔并接受这些服务的付款。然而，当前的CH平台需要大量的后端人工干预、处理和交付流程，这些流程可以通过实施可用的网络服务和一些关键流程的自动化来改进。尽管Dynamic Medical拥有丰富的经验和技术知识，但他们需要技术帮助才能利用当前的Web和基于云的技术。在合作中，Dynamic MedicalServices和Lambton College将专注于设计和开发一个强大的平台，利用新的可扩展技术堆栈通过自动化解决方案简化从接收到交付的业务流程。最终产品的成功开发和实施将为DynamicMedical客户提供额外的好处，并使业务能够增加容量。通过人工活动自动化改进的流程将节省时间，由于减少错误而提高准确性，并简化索赔的提交流程。强化和简化的流程将导致安大略省和省际市场的增长。反过来，这将为技术和行政部门创造更多的就业机会。此外，这也将对初级保健收费人和医院产生积极影响，他们将不再需要花费大量时间跟踪服务付款和治疗病人。