We delivered a web portal for helping insurance and healthcare providers charge for medical services timely and accurately.
We arranged this software project for a global provider of independent medical reviews helping reduce claim costs and decrease the overutilization of medical services. They needed a web portal where medical and insurance companies could define and charge accurate amounts of money for different medical services in accordance with the latest data security policies.
The company had already started building a system to perform these specific tasks, but it still didn’t meet data security requirements and the General Data Protection Regulation (GDPR) standards. That’s why the client was looking for a qualified insurance portal development team well-versed in both the GDPR compliance and medical app development.
The client chose MBicycle as experts in software development outsourcing to carry out this project. Our main advantage against competitors was previous experience with the development of medical solutions compliant with the GDPR. MBicycle’s developers were tasked with developing robust compliant software helping insurance companies assess the scope and quality of medical care delivered, in order to calculate correct coverage amounts.
As a solution to our client’s challenge, we launched a web portal that allowed several types of users to work with the client’s review and analytics system within their specific responsibilities.
Features by User Roles
Insurance companies’ employees can:
- Submit applications for consideration of medical cases
- Control the statuses of applications under consideration
- Define the coverage amount to be paid out for each application
Medical providers can:
- Consider, approve or reject applications
- Make a resolution on applications
- Define the amount to be charged for each application
The client’s quality control team can:
- Validate processed applications
- Request rework from the medical provider
The client’s system administrator can:
- Manage users of the system
- Manage and control financial ratios
- Set user access rights
- Tailor applications to different insurance companies
The client-side accountant can:
- Receive and process information about amounts payable to medical providers and remuneration charged from insurers
We worked out the distribution of roles and responsibilities for each user type in the system and created convenient data management interfaces for each user group. MBicycle’s web developers also implemented role-based access control to enable only a relevant set of features for each user type.
The developed system offers straightforward, manageable workflows for processing applications, enabling version control, ensuring data integrity as well as sustainable centralized collaboration on applications by all the involved parties.
MBicycle’s team followed the Kanban methodology while working on this insurance portal development project.
We set off by developing the architecture, which included preparing the project documentation and building basic architectural blocks.
At the next step, we enabled authorization and access distribution between different types of users as well as implemented privilege management screens. At this stage, we also developed a flexible design tool for the visual editing of applications.
The next milestone for our development team was to introduce the application processing workflow. To do this, our experts developed an application route designer with a set of built-in default routes. For tracking application statuses timely and with correct data displayed, we implemented a version control system.
At the final stage of creating the web solution for our client, the MBicycle team got down to the financial features. That was the most critical as well as time-consuming part of the project, where we developed:
- Screens for setting the rules to calculate amounts to be covered by insurance companies
- Screens for managing the rules to score prices for delivered medical services
- A tool for automatic calculation of all the payments depending on particular medical case parameters
- A financial report generator
Service-oriented architecture (SOA)
Spring Framework, Hibernate
Microsoft SQL Server
After this year-long insurance portal development, we delivered a multifunctional web solution that now helps medical and insurance companies to calculate and charge accurate sums of money for medical services delivered to their customers.
Our client got the ultimate solution to their challenge — a web portal with a number of features implemented, such as:
- Role-based access for different user types, along with privilege management dashboards
- Application lifecycle management
- A flexible design tool for editing applications
- A convenient workflow for application processing
- A route designer for applications
- A document version control system
- Finance management with rule-setting for calculating insurers’ coverage and payments to medical providers GDPR-compliant data management workflows
Cooperating with a huge international company while working on this project was a great experience for the entire MBicycle team. Our client was completely satisfied with the final solution, which is equally useful for medical providers and insurance companies worldwide.