Healthcare IT that holds up under pressure
Prior authorization, claims, coding, reconciliation and member systems — built, modernized and run by a specialist healthcare team, backed by the global scale of YASH Technologies.
Book a meeting with our healthcare teamY&L Consulting is a YASH Technologies company — a boutique healthcare team with the scale of a global group behind it.
Group figures reflect the combined YASH Technologies organization.
The key benefit
You don’t pay for the ramp-up.
Most firms bill you for three months of learning your environment before anything moves. Our healthcare teams already know NCPDP, 837s and 835s, prior-auth workflows, HIPAA constraints and what a 340B contract pharmacy actually does — so the work starts in week one, the estimates hold, and you get a working system sooner and for less.
The themes that keep coming up
Across providers, MCOs and payers — different organizations, the same pressure points.
Prior authorization
Requests tracked across portals, faxes and spreadsheets. Approvals land after care is scheduled, and missing authorization surfaces only when the claim is denied.
Coding mismatches and claims
Documentation gaps and coding errors clear internal checks and fail at the payer. The denial was decided at the point of service; nobody sees it until the remit returns.
Reconciliation and underpayment
Contract terms sit in PDFs and expected reimbursement is checked by spot audit, if at all. Small per-claim variances compound quietly across a whole book of business.
Utilization management and member access
Reviews, appeals, eligibility, billing and grievances spread across disconnected systems, so staff reconcile by hand and members call instead of self-serving.
Where AI is now doing the work
Each of these is scoped to one process, trained on your own history, and built into the screens your team already uses. We pilot it against a number before we scale it.
Validate claims before they leave
Codes, documentation and prior-auth status checked at order entry, while there’s still time to fix them.
Work denials automatically
Denials classified by reason, appeal language recommended, and each one routed to the right team.
Read every payer contract
Contract terms and fee schedules parsed, expected payment compared against actual, variance flagged.
Answer the routine questions
Order status, refills and billing handled by an assistant inside your existing portal.
Turn monitoring data into alerts
Continuous device data converted into fall, adherence and readmission risk flags inside the EHR.
Cut L1 support volume
Password resets, unlocks and installs resolved in chat, logged and tracked in ServiceNow.
How we’ve helped healthcare organizations
Four engagements, four different corners of healthcare.
Authorizations, claims, eligibility, billing and grievances sat in separate processes, so staff reconciled by hand and members called for everything. We split the member journey into self-service, personalised engagement and clinical management, then brought enrollment and renewal, provider search, authorizations, claims, transportation, remittances and ID cards into a single portal.
- High-volume transactions moved to self-service
- Utilization and authorization workflows in one place
- Member, provider and administrative access unified
A HIPAA-compliant virtual care platform across web, iOS and Android, built for six clinical and administrative roles. Encrypted messaging, video consultation with screen share, time-zone-aware scheduling, and integration to insurance verification and the EMR so eligibility and documentation are captured at the point of care rather than chased afterwards.
- Insurance verification integrated at the point of care
- Encrypted messaging and role-based access throughout
- EMR-integrated, AWS-hosted, native mobile and web
Financial flow, inventory and patient eligibility were reconciled across a large contracted network on a legacy platform that could no longer keep up. We rebuilt it as independently versioned services with module-level security, migrated the data, and replaced manual keying with bulk upload and dynamic reporting.
- Reconciliation across a large contracted network
- Role-level security across every module
- Manual keying replaced by bulk upload and reporting
A mandated data-interchange standard change landed in the same year as a middleware platform reaching end of life. We mapped the full field gap, documented the existing integration layer before touching it, then delivered inbound and outbound transactions in two phases instead of one cutover, testing every trading partner end to end.
- Full standards compliance across all trading partners
- Legacy middleware retired in favour of cloud services
- Phased delivery, no big-bang cutover risk
Why Y&L?
Six reasons healthcare organizations keep us on after the first project.
Healthcare specialists, not generalists
Teams who have shipped payer, provider and care delivery systems — and who speak your terminology on day one.
Boutique team, global backing
You work with a small healthcare team — with YASH Technologies’ 9,500 people, 43+ delivery centres and 100+ Fortune 500 clients behind them when you need to scale.
Compliance built in, not bolted on
HIPAA, FDA and GxP requirements designed into the architecture from the start, with validation and audit evidence to match.
We modernize in phases
We document what exists before we touch it and cut over in stages. No lift-and-shift gambles on systems that have to stay up.
Flexible delivery, sensible cost
Onsite, nearshore, offshore or core-flex across the YASH group’s 43+ delivery centres. You pick the mix that fits the budget and the timeline.
We stay after go-live
The same firm that builds it can run it — 24×7 infrastructure, service desk and application support. No handover cliff.
Book a meeting with our healthcare team
Tell us which system is causing the most trouble. We’ll bring a delivery lead and an engineer who has worked on it before, and spend the time on your problem rather than our credentials.
- 45 minutes, no slide deck
- A read on where the problem actually sits
- Two or three options with rough effort and sequence
- We reply within one business day
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