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.
Client Need
- 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
Our Solution
- 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%
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