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Implemented bots to improve eligibility & claims process capacity by 5x leading to huge cost savings

 

Client Background

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

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%
key Benefits of FHIR-compliant Automated Claims Submission & Monitoring

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