The project
PrimaCare exists as part of the SundhedsGruppen A/S and it represents a high-quality network of clinics, practitioners, and networks for health providers, whose project is also part of our portfolio since 2015.
This project consists of:
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Building web based solution for case management used by treatment providers
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Integration with insurance providers claim management systems by utilizing a REST API to automate the process for smart assignment of patient cases to individual treatment providers
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Integration with external financial systems to provide an automated invoicing process, for both purchase towards treatment providers and sales towards health insurance companies
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Automation the administration process by creating and managing all of the needed data, documentation, notifications and various processes in the network, by utilizing a paperless digital workflow
The goal
With this platform we strive to achieve full automation and optimized processes and workflow which enables PrimaCare to serve the needs of thousands of patients and rapidly introduce new products and adapt the existing ones.
The case management portal, the notification module, the insurance integration API, and the external financial system integration are important pieces that together complete the jigsaw and make PrimaCare the center part that connects the others - treaters, patients, and insurance companies.
The process
SPECIFICATION
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Specification by example
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Living documentation
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Close communication with the Prima-Care team
DEVELOPMENT & TESTING
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SQL Server database
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Modular & Multi-layer architecture
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Entity framework
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Web Portal in MVC, responsive design
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Web API
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Services for automation of processes
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Unit tests
DEPLOYMENT
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Automated test environment deployment with TeamCity
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Automated database migrations
SUPPORT AND MONITORING
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Automated issue reporting
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Monitoring with New Relic
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Logs and auditing
The result
This is a brand new product that did not exist in the market, and PrimaCare needed a bespoke software solution that has a central role in their IT strategy and infrastructure. The idea behind this project was to make the system act as a hub that offers the possibility to accept cases from external insurance companies, navigate them through the network based on their knowledge about distance, quality, customer satisfaction, etc. to select the best provider within their network, handle automatic payments and provide high quality detailed data with regards to the customers insurance package back to the insurance companies.
PrimaCare wanted to position itself as a fully automatic patient navigator through its network and an efficient cost center processor, so it can provide the right treatment for the patient and control the cost for the insurance provider by optimizing payments and offering an automated financial solution. Therefore, integration endpoints were needed to the insurance providers, PrimaCare accounting system and customer satisfaction polling system.
Besides designing, prototyping, and building the entire system from scratch we’ve been upgrading it constantly with new functionalities. Namely, the core activities of Primacare were managing networks of clinics and case management, integrated with another system (as part of an insurance company).
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