MedOps
Project Overview
MedOps partnered with Scimus to build a scalable solution for automating real-time insurance eligibility checks (RTE) across urgent care practices. The goal was to eliminate manual insurance verification at the front desk, reduce claim denials, and improve operational efficiency for clinics. Scimus delivered a custom backend system that powers MedOps’ RTE automation platform, currently in use by multi-location practices.
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Business Challenge
Urgent care clinics rely heavily on insurance verification to ensure services are reimbursed. However, the traditional process—manual lookups through payer portals or phone calls—is slow, error-prone, and burdens administrative teams. MedOps aimed to create a SaaS product that could:
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Integrate with clearinghouses like Availity to pull eligibility in real time
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Connect with popular EMR/PMS systems like Experity
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Automate verification workflows for front desk and call center teams
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Ensure secure credential management and multi-location scalability
Value Provided
Scimus developed the core infrastructure of the MedOps insurance verification platform with the following key features:
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API-driven eligibility checks: The system ingests patient and insurance data, formats RTE requests, and submits them via Availity’s clearinghouse API.
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Experity integration: Patient data is pulled directly from the practice management system and synced back once eligibility results are received.
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Credential vault: Scimus integrated OneLogin and a secure vault to store and manage payer portal credentials across practices.
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SaaS-ready backend: Built a multi-tenant environment with a usage-based billing model and partner pricing configuration.
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Scalability & Monitoring: Leveraged AWS infrastructure for scalable workloads, including Lambda for event-driven processing and CloudWatch for system health monitoring.
Business Outcome
- Manual insurance verification time reduced by over 90%
- Thousands of eligibility checks processed daily with minimal human intervention
- First product version launched in under 4 months
- Scalable for use across 50+ urgent care practices
