Health Care

The Healthcare domain has undergone a sea change due to the the focus it has received worldwide. The health care domain has gained so much focus due to the fact that the governments worldwide have brought about regulations to control this sector. This being a sensitive sector, the focus has been to network the healthcare systems and ensure that the regulatory compliance is followed as per norms. This requires a wide usage of latest technologies from the IT perspectives. Also the devices are also linked to this systems to ensure complete compliance. The health care domain is widely categorized as Payer side and the provider side. Our testing solutions in the Health care domain focus on these two categories:

Coverage

i. Payer - member - provider relationship

  • Systems and/or processes in the U.S. healthcare payer space
  • Underwriting, rating & actuaries
  • Broad category of payer systems
    • Plan & benefits administration systems
    • Plan design
    • Benefits design
    • Tasks performed by payer in the benefits design phase
  • Member management systems
  • Provider management systems
    • Provider contracting
    • Physician credentialing
  • Claims administration systems
  • Billing/accounting systems
    • Provider reimbursement
    • Premium billing
  • Supplementary payer functions
    • Wellness & disease management
    • Utilization review
    • Fraud & abuse analysis
  • ii. Provider Systems

  • Patient Management Systems
    • Patient admission and registration
    • Scheduling
    • Medical documentation and coding
    • Order entry
  • Administrative systems
    • Patient accounting
    • Patient service pricing
    • Patient billing and insurance claims
    • EDI (Electronic data interchange)
    • Receivables management
  • Financial management
    • General accounting
    • Resource management
    • Strategic information systems

  • Strategic information systems
  • Clinical support systems