Re-engineering of a custom peer-review management application

The client is a leading US-based behavioral healthcare services company providing behavioral health and medical review services to health plans, health systems, hospitals, and other insurers nationally. It is an independent review organization (IRO) acting as a third-party medical review resource. They provide objective, unbiased medical determination to insurance payers and providers and support effective decision-making, based on medical evidence. Their services help clinical and claims management professionals better allocate healthcare resources. 

The client’s existing application had several bugs and missing features that failed to meet the evolving needs of their business. The peer review management application was built using outdated technologies that led to usability and reliability issues, and there was a dearth of adequate resources and skillsets to look after the application maintenance. Moreover, it lacked compelling security features, which caused vulnerabilities against security threats and put the application at risk.  

The requirement was to redesign the custom-developed web application with enhanced features and implement a reporting tool to carry out tracking and analysis of the various peer review activities. 

Experion’s expert team of developers and solution architects redesigned the fully custom-developed web application for reviewing behavioral health and medical services. Developed using ASP. NET, the clinical peer review management application acts as an administrative backbone for an array of behavioral health and medical review services. It stores, organizes, formats, monitors and prepares cases for review. 

Experion is the sole development team responsible for both resolving bugs and managing the ongoing development of the web application. We have worked on fine-tuning the app to make it more effective using .NET resources and re-engineered features such as bulk upload, while being HIPAA compliant. We have also developed a customized reporting tool that tracks key metrics for internal process improvement and compliance and integrated stacks of case management tools into a single focused interface. 

The application makes it effortless for medical directors to process and review the case by channeling case information into a standard format that is consistent and easy to read. It minimizes the challenges of collecting and organizing case information from multiple systems, thereby helping organizations improve the speed and efficiency of the case review process.