"Healthcare" is a large industry where the consumers are entitled for care services while providers are entitled to get paid for the services they render.
Management Services Organizations come in to play to assure that both of these parties get what they are entitled for, meaning MSOs are supposed to make sure that quality care is delivered to patients while healthcare providers have a well managed revenue cycle and adiministration. This is not as easy as it is told because it involves many processes and a lot of work such as credentialling and payer contract management, utility management, appointments and scheduling, prior authorization, coding and claim adjudication prior to billing, billing, denial management, posting, categorization of patients based on health risks, following up with patients on their care plans etc. Due to this reason MSOs usually have a significant amount of staff who are specialized in each of these functions.
The goal of this application was to bring all of these processes under a single product and automating most of it whilst exposing statistics and supporting decision making.
Our client being a group of doctors, could not allocate enough time to explain these processes to our team, yet, however, utilizing on the fly research and fast prototyping we managed to deliver a working prototype that met ~90% of the application just the way we promise to all of our clients. Having started as a working Prototype MSO Care Orchestrator now functions orchestrating care across multiple healthcare providers in the US while utilizing only 20% of the staff it originally required.
