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Mid-sized North American Healthcare Provider

Reengineered insurance claims management on Microsoft Dynamics 365 — unifying EHR, email, and call center data into centralized case workflows, reducing denial rates by 75%, cutting A/R by 37 days, increasing monthly collections by $40K, and enabling real-time Power BI dashboards for leadership.

Result

65 → 28 Claims A/R days Healthcare RCM

Result

NATIONAL POS PLATFORM

Result

550M+ HL7 records

Challenges

  • Claims data was distributed across EHR systems, call centers, emails, and manual Excel sheets. There was no single source of truth.
  • Customer Service Representatives (CSRs) manually extracted data from EHR into spreadsheets before contacting insurers or patients for validation. Siloed systems significantly slowed resolution cycles.
  • There was no structured mechanism to monitor claim deadlines or ensure responses within the critical 90-day filing window, resulting in revenue loss.
  • Leadership lacked real-time dashboards to monitor.
  • Delayed validations and missed deadlines led to avoidable financial losses and operational inefficiencies.

Solutions We Provided

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Centralized Case Management

  • All claims, whether originating from EHR, email, or call center, were converted into structured cases within Dynamics 365, creating a unified operational workflow.
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EHR Integration & Data Consolidation

  • Integrated the existing EHR system with Dynamics
  • Automated claims ingestion
  • Eliminated manual Excel-based tracking
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Structured Workflow & SLA Monitoring

  • Defined claim lifecycle stages
  • Implemented ownership-based case routing
  • Enabled notes-driven collaboration
  • Established turnaround-time (TAT) tracking mechanisms
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Revenue Intelligence Dashboards

  • Claims aging
  • Processing volumes
  • Closure rates
  • Revenue risk exposure

Compliance-First Architecture

  • Role-based access control
  • Encrypted data flows
  • HIPAA-aligned security standards

Technology Stack

Key Deliverables

  • Revenue Realization
  • Cash Flow Efficiency
  • Denial Reduction
  • Aging & Revenue Leakage Control
  • Operational Efficiency
  • Revenue Protection
  • Executive Visibility
  • Compliance & Audit Readiness