Challenges
- Automate the eligibility determination process.
- Automate the claims administration processes that involve extensive manual intervention.
- FHIR Server for EHR certification for the clients’ PMS system to ensure secure data transfers in the format prescribed by HL7.
- Customization of their Hospital Information Management system to have reports and integration with the mobile app.
Solutions
- Implemented 20+ process bots using UI Path for automating manual routine tasks in patient eligibility and claims management.
- Built robots to extract patient eligibility details from Medicaid.
- Automated fetching latest claim status.
- Created an FHIR server for electronic transfer of data through secure API’s
- Created an authentication mechanism for secure transfer and use of data elements.
- Mapped data elements to FHIR resources from the database.
- Mapped data elements for 13 resources.
- Customized the legacy app for HIMS to add reporting capabilities.
- Developed a mobile app for appointment scheduling and tracking of patient information.
Tools & Technologies
Microsoft SQL Server, HL7 FHIR Foundation, API, WPF Microsoft .NET, UI Path.
Key benefits
- Saved about 90% of the manual effort.
- Robots produce consistent, highly efficient operations & customer satisfaction.
- Each robot saved about 50K $ to 100K $ per annum.
- Increased processing capacity by five times when compared to manual execution for eligibility check and claims administration.
- Client’s EHR got certified the first time.
- Reduced customer service center calls by 60%.
