HIPAA Medical Portals and eCommerce Healthcare

Most businesses that deal with protected health information (PHI) will have some eCommerce aspect that interacts with this data. They might use their sales portal for direct sales of medical equipment to customers, and many more have their billing connected to their medical portal. Insurance is also an inescapable part of running a medical-related business, whether the business is dealing with Medicare, Medicaid, private insurance, or some combination of the three. Having each of these financial and medical aspects handled by different software just doesn’t make sense, especially if the software won’t talk to each other.  

Ideally, a business will choose a platform and APIs that can incorporate everything they need — sales portals, patient/doctor portals, insurance integration, business applications — in one easy-to-access location. This is typically accomplished by using APIs and access to internal line of business applications to access information that may be stored in EMR-EHR. 

Insurance API Integration

During EMR-EHR integration, one of the most common connections is to government-based Medicare and Medicaid programs. Each of these forms of insurance coverage can have very different requirements when it comes to data and the fields that need to be gathered before claims can be made. Some of the government programs require very specific IDs and proof that the patient is part of the program. EHR integration experts like Clarity Ventures are going to have to get the field data for these users and validate this data using APIs to make sure that Medicare and Medicaid are going to cover the treatments. The software can also use API calls for most private insurance providers to verify insurance coverage very quickly — if not instantly — for different scenarios. Any situation that can’t be handled by an API can be flagged for human review. 

Give Users Control

One benefit of connecting sales portals to insurance is that the customer is the one inputting the information electronically. This can reduce the number of hours a company must spend gathering this information and putting it in. Customers can also change information as needed, correcting any information that they might have input incorrectly the first time. They can also update if they move addresses, and coverage changes as they move from job to job. 

In some cases, there may be a lab test that the customer must go through with their device that is recording their data, then additional steps will be required to get that data analyzed. For instance, they may gather the data at home and then need to go into the doctor’s office for a visit, or they may need follow-up labs performed to verify the results. Having APIs in place for insurance is very helpful for medical organization, because it can then see that this patient is going to have coverage throughout the long process. Knowing this before a patient walks through the door can alleviate billing problems in the future. 

Near instantaneous confirmation of medical insurance is important, but medical insurance APIs are also powerful when they detect that a patient doesn’t have coverage. Lack of coverage can trigger workflows so that uninsured patients are offered alternate options. This can include things like automatically presenting monthly payment options or other kinds of payment plans. It might also flag the customer so that a human can interact with them and give them choices about generic options. In other words, you don’t want to tell customers that their insurance won’t cover them without telling them that there may be other options. This can all be done through your HIPAA website which is connected to the patient portal. 

Clarity Can Help

Whenever you're looking at dealing with medical, caregiving, and support that would involve insurance, EMR integration solutions offers powerful options for the end-user and also for your internal organization, removing the need for the internal organization to complete steps manually that can be done in an automatic way.  

This is a very powerful option whenever you're leveraging a HIPAA medical portal and you're already working with PHI. Being able to offer the opportunity to help automate some of the insurance information and the payment information within a doctor / patient sales portal can be very valuable.