{"head":{"title":"How to Build a Medical Billing System | OceanLab","description":"How to build a medical billing and claims system: charge capture, coding, claims, remittance, denials, architecture, compliance and cost drivers.","canonical":"https://oceanlab.in/build/medical-billing"},"slug":"medical-billing","featured":[{"meta":{"slug":"singil","industry":"clinics","projectType":"Medical billing","country":"ph","tags":["healthcare","enterprise"],"compliances":["UHC Act (RA 11223)","PhilHealth case rates","PhilHealth eClaims","No Balance Billing","Senior Citizens Act (RA 9994)","PWD Act (RA 10754)","Data Privacy Act (RA 10173)","ICD-10 and RVS coding"],"cover":{"src":"/case-studies/singil/01-home.png","width":1440,"height":1000}},"text":{"en":{"title":"Singil - Hospital Billing and Claims Platform for PhilHealth and HMOs","description":"Designed and built a clickable billing and claims platform for a private hospital group in Quezon City, Cebu and Davao: patient accounts from first charge to zero balance, a bill that applies PhilHealth, senior and PWD discounts and HMO coverage in the right order, a discharge clearance board, and PhilHealth claims tracked against the filing deadline.","category":"Healthcare / Medical Billing","client":"Balangay Health Partners"}}},{"meta":{"slug":"qistas","industry":"insurance","projectType":"Health claims adjudication","country":"sa","tags":["insurtech","healthcare","enterprise"],"compliances":["Cooperative Health Insurance Law","CHI Unified Health Insurance Policy","NPHIES (HL7 FHIR)","ICD-10-AM and SBS coding","SCFHS clinician registration","PDPL"],"cover":{"src":"/case-studies/qistas/01-home.png","width":1440,"height":1000}},"text":{"en":{"title":"Qistas - Health Claims Adjudication with an Explanation on Every Line","description":"Designed and built a clickable claims adjudication platform for a Saudi cooperative health insurer: claims arrive through NPHIES, from member reimbursements or on paper, a rules engine decides each line with a trace and a provider explanation in Arabic and English, and only uncertain lines reach a medical reviewer.","category":"Insurance / Health Claims Adjudication","client":"Hadaba Cooperative Insurance"}}}]}