Claimsnet.com

Claimsnet.com supplies health care providers with complete, reliable electronic claims processing through a secure Internet connection and private extranet technology. The company sought a solution that would allow it to distribute its mission-critical application, CyberClaim, to its customers quickly and reliably over the Internet. It also wanted a solution that was easy to use and manage. Without the thin-client/server solution that used WinFrame, Claimsnet.com would not have been able to process medical claims over the Internet.

Presenting problem Several years ago, the founders of Claimsnet.com had the idea that electronic claims processing could be made available and affordable to all medical practitioners through the use of a secure Internet connection. Currently, of more than 4 billion claims submitted annually to payers by physicians and dentists, only about 35 percent of all medical and 10 percent of all dental claims are submitted electronically. Nearly all these submissions are by high-volume claims producers, such as hospitals and specialty clinics, which can afford the high setup costs of electronic claims processing. With fewer resources, small medical and dental offices which account for about 2 billion claims a year were being shut out of the opportunity to file electronically.

The challenge: Make information available through the use of secure Internet technology.

To extend electronic claims filing to smaller customers, Claimsnet.com developed CyberClaim, a robust, 32-bit Windows NT based application that enables confidential, easy-to-use claims processing and editing through the Internet. The company then turned its attention to finding a solution that could deploy CyberClaim quickly and reliably.

To this end, Claimsnet.com first attempted to create a bulletin board service through the Internet using a Novell NetWare based server. Despite a lengthy development effort, that plan was abandoned because the server downloaded the application s executable code to the client desktop, which slowed the system down considerably. Just to log on, a user was forced to wait seven minutes or more an unacceptable waste of time. The users needed a solution that would allow them to log on quickly and create a file that the payers would accept electronically.

After abandoning the bulletin board, Claimsnet.com began its search for a thin-client/server solution that would allow application processing to occur not at the customer site but at Claimsnet.com s central server site. As a result, users would gain LAN-like access to the application over the Internet.

Hardware and software The Claimsnet.com thin-client/server networking environment includes:

Claimsnet.com deploys its claims processing appli-cation to offices around the country.

• Compaq ProSignia Pentium Server with 64 MB of RAM
  
  
• Microsoft Windows NT and Novell NetWare file servers
  
  
• Dual T-3 connections to the Internet

Claimsnet.com uses Citrix WinFrame, in conjunction with proprietary client application software, to deploy its mission-critical CyberClaim claims processing application across the Internet to medical, dental, and outpatient offices throughout the United States.

Solution and results Citrix WinFrame provides Claimsnet.com with the high performance and universal application access its users need.

Claimsnet.com now affords thousands of medical practitioners, dentists, and outpatient clinics easy, low-cost electronic processing and rapid turnaround for their claims. Claimsnet.com has been able to provide this service while holding down its own costs and retaining centralized control over its widely distributed customer base.

Enables smaller organizations to process claims on line.

Once logged on to the system, users direct CyberClaim to access claims from existing medical or dental accounting applications, so the claims don t have to be rekeyed into the Claimsnet.com processing system. The system then automatically checks the claims for errors, a frequent and often inadvertent occurrence that can delay payment considerably. Errors are highlighted, and once corrected on line, the claims are transmitted to the insurance company for payment. Along the way, multiple levels of security, including firewalls and encryption, are used to ensure that the claims information remains confidential. Another benefit is the ability to print locally; users can print claims reports in hard copy if needed. The WinFrame server implementation also allows for remote training on claims filing. As a result of Claimsnet.com s thin-client/server implementation, health care professionals are getting paid more promptly than before, and just as important, they no longer have to commit large amounts of resources to filing, editing, tracking, and when errors occur refiling claims.

Although the Claimsnet.com service is still young, the company sees a huge market opportunity and room for rapid growth. Even as it expands, the company expects few growing pains with its thin-client/server solution. The solution will scale easily to meet the claims processing needs of Claimsnet.com s increasing client base. Moreover, by using a thin-client/server architecture, Claimsnet.com expects to be able to keep employee growth to a minimum, thereby retaining firm control over personnel costs. This technology will also eliminate the need for Claimsnet.com to create a large communications and support center for reporting and correcting network systems problems. In the meantime, servers are located and managed from a central location, giving the company maximum control over its service.