Challenges
- Client processes 900-1000 claims daily in the managed healthcare space which works on a partnership model between insurance payers and the State. The claims need to be split where one copy of the claim is sent to the payer and another to the state government
- Manual claim validations and claim splitting were performed which was time-consuming and needed large manpower for this repetitive process
- Due to high volume of transactions they needed to hire new FTEs but lacked office space for the new resources.
Solutions
- Automated the claim splitting process for two of the clinics associated with our client who use eClinicalWorks HER
- Build 5+ robots which can access the tool in client system and do validations for the pending claims like checking patient’s age, diagnosis, process code mapping, correct format for payer details and other common errors, and correcting them. If any errors can’t be corrected by the bot, then they are pushed into a different queue where it could be manually submitted
- Daily detailed reports of its activity are auto generated and sent to the client at EOD
Tools & Technologies
My SQL, Ui Path
Key benefits
- Reduced process completion time by 80%
- 6x increase in task completion rate and achieved high accuracy in processing claims
- Significant time and infrastructural cost savings while eliminating human errors from routine activities
