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Automated the eligibility determination process

 

Client Background

The client is a leading RCM company with a client base of more than 150+ hospitals, physician-specialist groups, independent labs, radiology centers and other providers.

Challenges

  • The client had a lot of manual intervention for their claims administration process which they wanted to automate.
  • They wanted to automate the eligibility determination process and also needed customization of their HIM system to have reports and integration with the mobile app.

Solutions

  • We implemented 20+ process robots 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 the electronic transfer of data through secure APIs.
  • Created an accreditation mechanism for secure transfer and use of data elements.
  • Customized the legacy app for HIMS to add reporting capabilities.
  • Developed mobile app for appointment scheduling and tracking of patient information.

Tools & Technologies

UI Path, Microsoft .Net, SQL Server, FHIR

Key benefits

  • Saved about 90% of the manual effort.
  • Robots produce consistent and highly efficient operations, and in turn, enhance customer satisfaction.
  • Increased processing of eligibility check and claims administration capacity by 5x when compared to manual execution.
  • Reduced customer service center calls by 60%.
Key Benefits - Automated Claims Validation Process - Healthcare

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