Introduction
Nalashaa, a leading solution provider in the field of robotic process automation (RPA), undertook a transformative project to enhance the claims status check process for a prominent player in the RCM space within U.S. healthcare. The objective was to eliminate repetitive manual tasks, ushering in a new era of efficiency in Revenue Cycle Management (RCM).
Client Challenge
The client faced a critical challenge in ensuring the swift resolution of claims. The existing process demanded constant manual checks on unprocessed claims, each with different statuses such as Deferred, Accepted, Denied, or Closed, triggering specific actions. The manual, repetitive nature of this process led to delays and inefficiencies in claim settlements.
Solution
Nalashaa meticulously crafted a sophisticated ROBOT to automate the intricate claims status check process. The RPA system executed a precise sequence of tasks:
Read the Claims Reports
The bot intelligently processed reports containing diverse claims information.
Search the Claim
Seamlessly navigated carrier portals, precisely locating claims using claim numbers and dates.
Send Status via Email
Automated the dissemination of all reports via email, empowering the client with timely and actionable insights.
Identify the Carrier
Through advanced analysis, the bot determined the respective portal for each carrier to efficiently check the claims.
Extract Claim Details
Upon locating the claim, the bot extracted vital information, including claim status and denial reasons.
Benefits
The implementation of RPA resulted in tangible and realistic benefits for the healthcare entity.
RPA operated tirelessly without errors and strategically handled the workload equivalent to 2 to 4 regular employees.
The RPA system expedited task completion, ensuring swift claims settlements, and reducing overall processing time.
The manual data entry burden was alleviated, allowing skilled resources to focus on more nuanced tasks, enhancing overall operational efficiency.
Automation systems demonstrated superior accuracy in handling repetitive tasks, significantly minimizing the risk of errors inherent in manual processes.
By replacing 2-4 workers, the deployed BOT resulted in substantial cost savings for the company, aligning with the client's financial objectives.
Before BOT
Total number of FTEs supporting activity: 4
500 transactions in 24hrs
Time consumed per transaction: 5 minutes
After BOT
FTE Saving: 95%
500 transactions in 12.5 hours
Time consumed per transaction: 1.5 minutes
Technology Stack
Remote Desktop Connection
Insurance web portals
Front office web portal
Worth Exploring
A glimpse of our industry expertise