Automated Case Management System for Medical Billing Dispute Resolution

The client faces high error rates in medical billing, leading to patients overpaying due to billing inaccuracies. Manual case handling processes limit scalability, create bottlenecks, and hinder timely resolution. Additionally, the sensitive nature of patient data demands robust security measures. The current contact and case management workflows are inefficient, restricting the service’s growth and ability to serve more patients effectively.

A mid-sized healthcare advocacy organization specializing in resolving billing errors and reducing patient expenses through case dispute management.

• Develop a secure, HIPAA-compliant digital application enabling users to easily file billing disputes and track case progress.
• Automate case assignment and management workflows to reduce manual intervention and improve operational scalability.
• Implement features allowing advocates to manage multiple cases, request additional documentation, and organize notes efficiently.
• Enhance user experience by providing real-time case status updates and streamlined communication channels.
• Establish a cohesive brand identity that builds trust, communicates professionalism, and conveys confidence in dispute resolution services.
• Enable administrative oversight for case assignment, workflow management, and data security compliance.

• User-friendly online dispute filing form capturing all necessary initial case information without overload.
• Secure, HIPAA-compliant storage and management of sensitive patient and billing data.
• Case dashboard for advocates to view, update, and organize multiple cases simultaneously.
• In-system communication features for advocates and users to exchange messages securely.
• Workflow automation to assign cases to specific advocates based on predefined criteria.
• Notification system for updates, document requests, and case status changes.
• Administrative panel for managing case assignments, user access, and security settings.

• Secure messaging platforms for user-advocate communication.
• Document management and upload services.
• User authentication and authorization systems, including role-based access control.
• Notification and email services for alerts and updates.
• Billing and payment processing, if applicable.

• System must support scalability to handle increasing user and case volumes, targeting a growth of 200% within the first year.
• Application must achieve 99.9% uptime and load times under 3 seconds for core functionalities.
• Full compliance with HIPAA and other relevant data security standards.
• Data encryption both at rest and in transit.
• Role-based access controls and audit logging for all sensitive actions.

Implementing this automated, secure, and user-friendly case management platform is expected to significantly reduce manual handling bottlenecks, enabling the organization to scale operations efficiently. The system aims to increase case throughput, improve resolution accuracy, and enhance user trust, ultimately leading to higher patient satisfaction and reduced overpayment amounts. The automation and improved workflows are projected to support an increased case volume, potentially doubling the organization’s capacity within the first year.