PilotFish Powers Nonprofit’s Transition to NextGen with Seamless Integration and Improved Workflows

This nonprofit organization provides critical services to over 40,000 individuals annually and faced significant challenges with its billing system and data integration processes. As their transaction volume grew and their systems reached capacity, the organization struggled with manual data entry, insurance eligibility verification and a lack of in-house HL7 expertise. To overcome these issues and transition to a new billing system, they turned to PilotFish for a flexible, scalable integration solution. By automating key processes and implementing automated data integration solutions and seamless data interfaces, PilotFish enabled the organization to streamline operations, improve data quality and accuracy and enhance operations in healthcare data management in a matter of weeks.

THE CLIENT

The client is a renowned not-for-profit organization based in New York with over 60 years of experience providing life-changing services to individuals, families and communities in need. With a mission centered around creating more robust, healthier communities, they serve over 40,000 individuals annually. Their programs focus on addressing critical issues such as addiction, homelessness, mental health challenges and the needs of underserved populations.

The organization operates various programs, including outpatient counseling centers, residential treatment facilities and supportive housing programs. These services are designed to offer comprehensive care for individuals struggling with substance use disorders, mental health issues and housing instability. Their target population includes those experiencing homelessness, veterans, individuals with behavioral health challenges and people recovering from addiction.

Through a holistic approach, the organization offers not only addiction recovery and behavioral health services but also educational programs, job training and support with housing and social reintegration. This multifaceted care model aims to provide individuals with the tools and support they need to lead healthier, more stable lives.

With a growing demand for services, particularly in the wake of the opioid crisis and increasing homelessness, its operations have expanded. However, this growth increased strain on their internal systems, especially in managing high volumes of data related to patient care, insurance eligibility and billing. To continue providing high-quality care efficiently, the organization recognized the need for a robust, scalable data integration solution to meet their evolving demands, leading them to seek PilotFish’s expertise.

This case study details how PilotFish’s integration platform helped them overcome these operational challenges, ultimately improving their ability to serve vulnerable populations more efficiently and accurately.

THE CHALLENGE

As the organization grew, so did the demands on its systems, particularly those related to billing and data integration. The organization’s legacy billing system could no longer keep up with its operational needs, creating several pain points:

• Transaction Limit Reached: The billing system was overwhelmed by processing approximately 33,000 transactions each month, leading to delays and bottlenecks that affected the organization’s ability to deliver timely services.
• Manual Data Extraction: Data integration processes, particularly eligibility checking for insurance claims, required significant manual effort. This increased the potential for human error and created inefficiencies, with staff members spending valuable time on tasks that could otherwise be automated.
• Lack of HL7 Expertise: The organization did not have an in-house HL7 developer, which limited its ability to integrate with modern healthcare systems that rely on HL7 interfaces for data exchange. Without these interfaces, communication between different internal systems and external partners, such as insurance providers, was hampered.
• Complex Data Mapping: Transitioning to a new billing system (NextGen) required seamless integration of data points and fields from existing systems, necessitating robust data mapping processes that were difficult to manage with limited resources.

The lack of automation and integration capabilities negatively impacted operations, causing unnecessary delays and inefficiencies. The organization needed a modern, scalable solution that could address these issues while remaining adaptable to future needs.

THE SOLUTION

Recognizing these challenges and reviewing vendor offerings, the organization turned to PilotFish for a solution that could provide them with seamless data integration, process automation and scalability. PilotFish delivered a comprehensive integration platform tailored to meet the organization’s unique needs.

Key elements of the solution included:

Seamless HL7 Interface Integration

HL7 (Health Level 7) interfaces are critical in modern healthcare for the exchange of information between systems. PilotFish’s healthcare integration platform enabled the development and deployment of these interfaces, facilitating the secure, HIPAA-compliant transfer of healthcare data, including patient information and billing data, between the client’s systems and external platforms, including their new billing system, NextGen.

This integration allowed for real-time data updates, ensuring that billing information, patient demographics and insurance details were accurate and readily accessible. Introducing these HL7 interfaces eliminated the need for manual data entry, significantly reducing errors and administrative overhead.

Automated Eligibility Verification

Before working with PilotFish, the client’s staff manually checked patient insurance eligibility—a time-consuming process prone to delays and mistakes. PilotFish automated this process through API integrations, which connected them directly to insurance providers’ databases.

This automation allowed staff to verify insurance coverage almost instantaneously, freeing up resources for more mission-critical tasks. As a result, the organization saw a significant reduction in eligibility-related issues, contributing to smoother billing operations and fewer rejected claims.

Comprehensive HL7 Training and Support

Understanding that the client lacked dedicated HL7 developers and experience, PilotFish provided in-depth training on its platform, particularly in using XSLT (Extensible Stylesheet Language Transformations) critical for the data mapping phase of interface development with Pilotfish’s eiConsole graphical IDE. This training empowered the organization’s in-house SQL developers to create, modify and manage interfaces without needing specialized HL7 knowledge.

The training sessions also covered best practices for data mapping, interface building and error resolution, ensuring the client’s team could confidently handle day-to-day integration tasks and adjust as needed.

Flexibility and Scalability

A core advantage of the PilotFish platform is its scalability. As the organization continues to grow, the solution can easily be expanded to accommodate additional interfaces and data sources. Whether the organization needs to integrate new healthcare systems, expand its billing operations or incorporate new data formats, PilotFish provides the flexibility to evolve alongside their needs.

This future-proof approach means the client can continue expanding its services without worrying about outgrowing its integration capabilities.

Communication between all parties was critical to the initiative’s success. The integration project commenced with a Kickoff Meeting to align all stakeholders, set clear goals and define the project timeline.

The implementation process included several key phases:

Phase I – Infrastructure Setup

PilotFish collaborated with the client’s IT team to ensure the necessary infrastructure was in place. This included setting up VPN connectivity, remote desktop access and ensuring the availability of server resources. All team members were provided with the required permissions and tools, such as SQL Server Management Studio, to ensure a smooth transition to the new system.

Phase II – Requirements Gathering and Data Mapping

A critical aspect of the project was gathering data from existing SQL queries to understand how various data points would map to the new billing system (NextGen). PilotFish worked closely with the client to collect these requirements and design workflows that were aligned with their operational needs.

Phase III – Interface Development and Testing

With the requirements in hand, PilotFish began developing the HL7 interfaces and other data integration workflows. Each interface was rigorously tested to ensure seamless data flow between systems, with particular attention given to eligibility verification and billing processes.

Phase IV – Training and Knowledge Transfer

As part of the implementation, PilotFish conducted extensive training sessions with the staff to ensure they were fully equipped to manage the platform. This training covered not only the technical aspects of the platform but also practical use cases that the staff would encounter regularly.

THE BENEFITS

The client experienced significant improvements in both their operational efficiency and data integration processes after implementing PilotFish’s platform. By automating previously manual tasks such as real-time insurance eligibility verification and automated data entry for healthcare billing, the organization was able to reduce administrative burdens, allowing staff to focus on higher-value activities that directly impact patient care. This increased efficiency not only streamlined workflows but improved the overall quality of services provided to their clients.

In addition, implementing HL7 interfaces eliminated the risk of human error associated with manual data entry. This automation led to more accurate billing and patient data, which in turn reduced the number of rejected claims and helped create a more predictable revenue stream.

The enhanced accuracy and reliability of data transfer between systems allowed the organization to process information faster and more precisely.

PilotFish’s integration platform also provided the flexibility and scalability necessary for future growth. As the organization continues to expand its services, it can easily add new interfaces, integrate additional systems and scale up its data processing capabilities without needing significant infrastructure changes. This scalability ensures the organization is well-equipped to handle increasing demands while maintaining seamless operations.

Additionally, the training provided by PilotFish empowered the client’s internal team to take control of their integration processes. Staff members gained the skills needed to manage and modify interfaces independently, reducing reliance on external consultants and giving the organization greater autonomy over its systems.

By partnering with PilotFish, the client could not only overcome immediate challenges related to billing and data integration, but it also laid the foundation for long-term success. The streamlined processes improved data accuracy and empowered staff, allowing the organization to continue focusing on its core mission—providing vital services to those in need. With PilotFish’s scalable integration solution, this nonprofit is now prepared for future growth and ready to deliver high-quality care to the communities they serve.

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