API for pre-validated Medicare claiming set for launch

Written by Kate McDonald on .

Melbourne start-up company claiming.com.au is about to launch a new technology platform that promises to make integrating Medicare billing with practice management software a much easier process.

Claiming.com.au has developed an API it will market to general practice and allied health software vendors to allow them to easily integrate online claiming with Medicare and the DVA.

For end users, the technology aims to speed up the response times of their Medicare claims, by using an efficient queuing system and data pre-validation. It will also enable users to see in real time that a claim has been rejected, and for what reason.

Claiming.com.au has been established by Dr Tony Stewart, a medical practitioner and founder of medical billing solution provider Cutting Edge Software; his son Sam, an IT entrepreneur; and web applications developer Damien Whitten.

Sam Stewart said his father's stories about the complexities of medical billing and Medicare claiming had encouraged the team to find a way to make the whole process as easy as possible.

“My background is in start-ups and early-stage tech innovation,” Mr Stewart said. “My dad has been operating Cutting Edge Software for the last eight years and it would routinely strike me just how complex it was. I knew there had to be an easier way. We are trying to make it as easy as possible for anyone to plug into medical billing in Australia.

“The way that we improve it is really two-fold. One is an efficient queuing system so that developers will send [a claim] through to us and we will hold it and ping it off for submission. We will meter it and keep sending it through to Medicare at a rate that they can handle, and only send it back out when it is ready.

“The other is the pre-validation. Because we are taking the rule set from what has been operating with Cutting Edge Software for the last eight years, we have a field-tested idea of what a valid or invalid claim should be. We can say 'you have put these three item numbers together on a claim and that can't go through', and notify the end-user before at the time of data entry.

“We do that pre-validation at the time of input by the user. This requires some cooperation from developers tapping into our API properly, but we will work with the developers to make sure that they can do that as easily as possible.”

The platform will enable immediate membership number validation but will also bring up a plain English error message if an invalid claim is entered.

“This compares to the traditional path which was the user would put it in perfectly fine and submit it and get an error message, or if sending it via the paper channel, two months later they'd get a notification coming back saying you can't get paid for this.

“For the medical software vendors, the real focus is, once integrated with our API, their cash flow should significantly improve.”

Mr Stewart said the company would target the smaller software vendors first, particularly those working with the allied health sector, but there was definite scope to work with the established Medical Software Vendors software vendors who have to spend an inordinate amount of time re-engineering their integrated billing systems.

“We'll offer a pretty tangible cost saving to them as well because of how easy it is to integrate with us, as well as the pretty significant amount of engineering time that goes into maintaining it and making sure Medicare doesn't go down. Ultimately we will look to expand our support for other types of billing in the sector, but at the moment it is very much focused towards Medicare and DVA.”

There is also scope to work in the future with billing systems that use terminals, such as HICAPS and Tyro. The company has recruited Simon Terry, former CEO of HICAPS, in a business development and advisory role.

Mr Stewart said that there was a fundamental issue with terminal-based solutions in that they fall short when it comes to developing mobile solutions or anything that is cloud based.

“There are only a few players out there doing things that I consider cutting edge technology. So we’re building the technical infrastructure that will enable all software developers to spend time on things that matter, like cloud technology, better design or user experience.

“I might be taking a shot in the dark here but one of the reasons that they haven't been able to do it is that they've been so bogged down in doing things like integration with Medicare. With us, they can then afford to work on some more cutting-edge, innovative things.”

Cloud and mobile solutions make a lot of sense for mobile professionals, but Mr Stewart also believes GPs will eventually see the benefit of cloud-based software, more generally.

“Allied health feel this problem more acutely and mobile technologies for them just makes sense,” he said. “Having an iPad app that they can just tap into, and do their billing right there at the time of consultation, just makes real sense.”

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