ARCHITECTURE
The
Vericle system validates the claim, verifies insurance
benefits, submits the claim, tracks the charge,
and verifies the proper payment, all automatically.
Rather than extending existing approaches and systems,
Vericle applied processes and software tools previously
utilized for automating complex financial processes,
such as bond trading. Leveraging state-of-the-art
intelligent computing, decades of medical billing
expertise, and Internet connectivity, Vericle has
created an engine to dramatically increase efficiencies
of the entire billing process.
Vericle’s key aspects, namely, Straight Through
Billing and Transparency, require effective workflow
management, knowledge base validation system, and
connectivity to all process participants, including
on-line reconciliation and tracking. Accordingly,
the Vericle platform is a three-tier enterprise
application:
- The back-end processing engine was derived
from Straight Through Processing systems built
for high-volume transaction processing environments
in Financial Services firms, such as Lehman
Brothers.
- The middle-tier uses Java Servlet technology.
- The front-end is an HTML-JavaScript zero-footprint
client.
The application is hosted on multiple Linux servers,
providing high availability and fast performance.
It processes today roughly 1.5 million rules per
claim at an average rate of 500 claims per second
across multiple processors. All batch processing
is ACID compliant, delivering maximum reliability
for critical financial transaction processing.
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