InfiniHealth IPA needed to move its medical claims workflow off Google Sheets and onto a system that could keep up with payer data, contract rules, and provider payouts without manual re-entry at every step. We built an internal platform that imports payer-adjudicated claims directly from portal CSV exports, validates paid amounts against each provider’s contract terms, and flags underpayments or discrepancies automatically.

The system also handles dispute tracking, batches payable claims by provider, calculates batch totals, and generates standardized EOP documents ready to send. Because the same claim can reappear in later CSV exports with updated data, we designed the import as upsert-based, so records get updated in place instead of duplicating — a requirement that doesn’t show up in most claims tools but was essential for how InfiniHealth’s payer data actually behaves.