Challenges
- Automate day-to-day operations to create claims, fetch in-patient admissions, care index, and authorization details of multiple health plans or health systems
- Automate processes dealing with manual edits and load these files for downstream systems to calculate the quality measures, reimbursement rates, and population health
Solutions
- Implemented 52+ process robots using UiPath for automating routine manual tasks
- Developed robots to create claims and download files for pre-authorizations, in-patient admissions, discharge information, HEDIS rates, and medical conditions
- These robots can access multiple healthcare systems and perform all operational tasks like finding specific plan patient care information, member pre-auth files
- Robots were configured to edit the downloaded files as per clients’ proprietary format and load edited files into client’s system
Tools & Technologies
Ui Path, Microsoft SQL Server
Key benefits
- Significant time and cost savings while eliminating human errors from routine activities
- 5x increase in processing capacity when compared to manual execution
- Robots enable consistent, highly efficient operations that result in higher customer satisfaction
- Enabled end-users to perform value-added tasks and executed pre-determined workflows to assist them further
