The problem
A Canadian healthcare platform was processing OHIP insurance claims by hand. Eligibility checks, payment reconciliation and EDI batch submissions each needed a person in the loop.
The approach
We integrated OHIP APIs for real-time eligibility verification, built MCEDT/WSDL payment reconciliation, and automated XML/EDI batch claim generation with rule-based validation. Exceptions route to a review queue; everything else submits itself.
The outcome
Claims validate, batch and submit overnight. Reconciliation runs on its own. The team reviews exceptions instead of typing claims.
A Canadian healthcare platform was processing OHIP insurance claims by hand. Eligibility checks, payment reconciliation and EDI batch submissions each needed a person in the loop.
The build
- Real-time OHIP eligibility verification via API
- MCEDT/WSDL integration for payment reconciliation
- Automated XML/EDI batch claim generation
- Rule-based validation before every submission
- Exception queue for the few claims that need a human
100%
Claims processed automatically
80%+
Manual data entry eliminated
Outcome
Claims are validated, batched and submitted overnight. Reconciliation runs on its own. What took a team days now finishes before the office opens, and the team reviews exceptions instead of typing claims.
Integrated directly into the platform’s ERP, so billing, patient records and payments share one source of truth.
