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PRODUCTS

Wahin - Web Application for Health Insurance Networks

Wahin is a web application specifically developed for Health Insurance Networks. Its mission is to help the Health Insurance Companies to save money as well as to provide valuable information that would help decision making. The initial idea came from a Health Insurance company, which was complaining that the Members (patients) have difficulties with making appointments with doctors (takes too much time, in many cases they get put on hold for long time, etc.) and eventually they just go to the emergency room which costs more money to the Insurance company. We started from the development of a Scheduling System that would allow the both the Members and Doctors (when they want to refer their patents to other Doctors) to search for health providers by different criteria and be able to request an appointment with many providers at a time and then just choose one from those who replies. The following is the brief description of the system.

Scheduling System

Wahin has a powerful scheduling system that allows the members to make doctor (or any kind of provider) visit appointments without the hassle of making phone calls. The same system is also used by doctors for referring their patients to other doctors. In other words the doctor’s office can make an appointment with another doctor on behalf of their patient.

Here is how it works:

• A user who wants to make an appointment first runs a search for providers by filling out a search form. In that form the user can point out the type and specialty of the provider he/she is looking for, and/or search by doctor or practice name, and/or search by available time for appointment.
• Once the search results are brought to the user he/she can choose one or more providers the appointment request will be sent to.
• The appointment request form includes a short note where the user describes the reason for the visit, the preferred date and time of the visit and the alternative date and period of time (Wahin forces the user to enter not a certain alternative time, but a period of time, which dramatically increases the probability of the doctor’s office’s ability to match a time for this patient).
• Once the request is submitted all the providers that were selected in the beginning of the scheduling process immediately get notified about the new request. The notification is made both visually on the designated operators computer at the doctor’s office (blinking), and by sound.
• The doctor’s office can look at the details of the request (the information submitted in the appointment request form). Moreover, they can immediately see the Eligibility and Benefits Summary of the patient for whom the request was submitted. This feature saves lots of time for the doctor’s office.
• At that point the doctor’s office has several options:
  - Decline the request
  - Accept the requested preferred time for the visit
  - Accept a certain time from the alternative time period
  - Suggest their own date and time for the visit
• Once a response to the party who placed the request is sent by the doctor’s office it becomes immediately available to the member and, in case if the response was submitted by another doctor’s office on behalf of the member, to the party that had placed the request.
• If the response from the doctor’s office is positive (not a decline) then the member has a certain time to confirm the appointment. It is a deadline for member’s confirmation set by the doctor’s office. If no response is received from the member by that time then the system automatically deletes that appointment request from its database.
• The member reviews the received response from the doctor’s office and confirms one of them. The system now has a scheduled appointment.
• At any time any of the parties may either cancel a scheduled appointment or request its rescheduling.
• The doctor’s office can enter a confirmed appointment into the system (in case if they get the patient’s confirmation through personal contact with him/her).
• The doctor’s office can mark an appointment done prior to its due date and time (in case if the visit takes place before the appointed time).
• The Member may cancel an appointment up to 24 hours before the appointment time – if the appointment is cancelled within 24 hours from appointed time then it is considered a missed appointment.
• Wahin allows referrals of patients from one provider to another. The process is the same as described above except that all the functions performed by the member are performed by the referring doctor’s office. When a request for appointment arrives at a provider’s office it clearly shows whether the request was initiated by a member or another provider.

Pre-Certification

For the procedures that require pre-certification the provider’s office can fill out a pre-certification request form and submit it. Once submitted, the form is immediately posted to the party responsible for approval of the pre-cert requests (can be a third party company – in that case they must have a server available for this functionality).

Once the designated specialist reviews the pre-certification request and makes a decision it is posted back onto the Wahin system and the requesting provider immediately gets notified that the response has been received and they can review it on the Wahin site.

Other Services

Claims. The provider’s office can review the status of the claims that have been placed by them. Also the member can review the claims that have been posted against services to him/her.

Eligibility and Benefits Plans. Regardless of whether the doctor’s office received an appointment request through Wahin or not, they can search for a member (by First and Last name, as well as by Social Security Number) and review his/her Eligibility and Benefits Plan.

Profile Maintenance. All types of users are able to edit their profiles at any time. This includes demographic information for members and

Credentialing System

Wahin has a separate module for the Insurance Company itself to maintain the database of the Providers, generate reports and do many Administrative tasks. The Health Provider’s Profile includes:
• general information,
• demographic information,
• short description (any text),
• List of the Provider’s locations (addresses and phone numbers),
• Lists of the Provider’s:
- Specialties,
- Spoken Languages,
- Educational Degrees,
- Affiliations,
- Boards,
- Insurance Networks the Provider is member to,
- Licenses.



 
 

 
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