Dakota hires Miratech to create Health Claim Expert for insurance industry

Customer

Dakota Imaging Inc., Maryland, USA (the part of Emdeon Business Services, www.emdeon.com, since 2004) is a leading provider of turnkey solutions and ASP services for automated data capturing, transaction processing, document imaging, and document management. Dakota provides ready-to-use solutions for various high-volume transaction processing applications to healthcare insurance and fulfillment and government markets.

The Challenge

As a leading industry provider, Dakota Imaging is always aware of the quality, time-to-market, and the cost of its solutions. Market and competitors' pressure forced Dakota to find a software solution that would enable it to radically speed up claim processing logic development and reduce the cost of the effort at the same time. Existing development procedure was highly complicated and time-consuming.

Solution

As a main Dakota Imaging’s vendor of software services Miratech was selected to focus on above challenges.
The target adduced to Miratech was to develop an industry-specific expert system. The system had to encapsulate industry-specific business logic and enable the client's specific customizations.

As a result, the Health Claim Expert (HCE) an expert system for HCFA 1500 and UB-92 medical insurance claim form was designed and developed by Miratech. Miratech has applied all its domain form processing expertise to create a set of business rules delivering the perfect trade-off between form processing speed and quality. Furthermore, the expert system was designed in a way that enables an easy customization and tuning, quick implementation, and upgrading. Over the years, Health Claim Expert remains a world leader in form processing.

These technologies and tools were selected: XML/DOM, Perl, IBM AIX, Windows NT.

Value to customer

The Health Claim Expert not only enabled Dakota to reduce its time-to-market frame by 3-5 times but also allowed them to save over 5000 man hours while implementing health claim processing logic for their clients.