Automating Insurance Verification for a Leading Urology Practice
Introduction
Nalashaa partnered with a leading healthcare provider specializing in urological care in Tennessee. Renowned for quality clinical outcomes and patient-centered service, the practice manages over 120 patient appointments daily. This scale of operations requires strong administrative support to ensure seamless coordination across clinical, billing, and operational workflows.
Business Requirement
Patient insurance eligibility check and benefits verification was the most resource intensive process. This step, although necessary for accurate billing and better patient communication, was handled manually by staff through the eClinicalWorks (eCW) web application and several third-party insurance portals. Each check required navigating different user interfaces, entering patient data multiple times, and interpreting varied coverage details, which led to delays, inconsistencies, and a heavy administrative burden. These repetitive tasks consumed significant staff time and affected employee morale due to their monotonous nature.
As patient volumes grew, this manual process added complexity, increased time demands and made the workflow harder to scale. The reliance on human effort continued to slow operations and increase the risk of errors. The following challenges highlight how these factors impacted productivity, accuracy, and the patient experience:
Manual Workload
Staff had to log into multiple insurance portals and the eCW system to retrieve and update patient insurance details.
Data Entry Bottlenecks
Copying coverage data like copays, deductibles, and coinsurance into patient charts was laborious.
Error-Prone Processes
Manual inputs increased the risk of inaccuracies in billing notes and patient balances.
Claim Denials
Manual inaccuracies in eligibility checks occasionally led to insurance denials, causing delayed reimbursements and increased rework for the billing team.
Scalability Issues
The growing patient base strained the team’s capacity to verify insurance details efficiently before appointments.
Patient Communication
Inaccurate or late verification sometimes delayed patient notifications about out-of-pocket expenses, affecting satisfaction and preparedness.
The Fix? An Intelligent RPA Solution
We designed and developed a comprehensive Robotic Process Automation (RPA) solution using UiPath, tailored to automate critical steps of the insurance eligibility and benefits verification workflow:
Patient List Extraction
Automatic extraction of scheduled appointments directly from the eCW application.
Multi-Portal Verification
Eligibility and benefits check across six insurance portals (e.g., Availity, Cigna, Mutual of Omaha).
Structured Data Capture
Retrieval of copay, coinsurance, deductibles, and coverage status details.
Real-Time eCW Updates
Automated updates to billing notes and secure attachment of benefits documents to patient records.
Compliance-First Deployment
Bots deployed on internal servers, ensuring no PHI leaves the organization and full HIPAA compliance.
Reusable Payer Workflows
Standardized handling of payer logic for modular development and scalability.
Dynamic PDF Generation
Verified benefits compiled into standardized PDFs using clear conventions for traceability.
Data Pre-Validation
Insurance data is pre-validated to minimize downstream errors.
Smart Record Segregation
Automated sorting of records by verification method to streamline processing.
Bot Orchestration
Config-driven bot execution after office hours to avoid operational interference
Environment Parity
Dedicated bot server configured to mirror production environments, ensuring reliability during runtime
Centralized Configuration
Secure credential management and exception handling
Portal-Specific Abstractions
Layered design to manage variations across payer portals without disrupting the core bot logic
Resilient Error Handling
Fail-safes, retry logic, and automated email alerts for issues like portal downtime or incorrect credentials
Compliance by Design
Minimal data exposure with encrypted communication between bots and systems
Data Harmonization
Use of Excel-based transformation and mapping of insurance methods with verification processes
Scalable Architecture
Easily extendable to accommodate new payers, validation rules, and additional automation layers
Implementation Roadmap
To ensure a seamless rollout, the automation journey was executed in a series of tactical steps, each informed by front-line bottlenecks and fine-tuned through iterative feedback. Here’s how we brought the automation to life
On-ground Process Walkthroughs with Admin Staff
Instead of starting with generic documentation, we shadowed the front-office and billing teams to observe their workflows firsthand, capturing nuances like partial benefit visibility on certain payers and inconsistent data formats across portals.
Workflow Design Using Real Scenarios
Automation logic was modelled using actual patient records and edge cases (e.g., secondary insurances, inactive plans). This helped pre-empt gaps that could disrupt automation in production.
Agile Bot Development with Early Prototypes
We developed lightweight bot prototypes for each payer and demoed them live with stakeholders. This provided early validation and minimized change requests later in the cycle.
Seamless Plug-in with eCW for Real-time Updates
eCW integration was fine-tuned to automatically update billing notes and attach benefit PDFs, giving the front desk up-to-date information at the point of care without toggling screens.
Controlled Pilot with 500 Patient Records
Instead of rushing into production, we ran a pilot with 500 appointments over three days, logging exceptions and tracking processing time. This resulted in a 28% performance improvement after optimization.
Deployment on Client-Hosted Server for Compliance
We deployed the bots locally on a secure server within the client’s infrastructure to ensure no PHI left the organization, removing compliance concerns and IT security approval hurdles.
Key Activities
Requirement gathering and stakeholder alignment with client.
Designing automation workflows for patient data handling and verification.
Development and unit testing of bots across all portals.
Integration with eCW system for billing note updates and documents.
Conducting UAT with 500 patient records for performance validation.
Final deployment on a dedicated, production-like bot server
Key Features & Benefits to the Client
The solution automates logging into payer portals, navigating their interfaces, and extracting eligibility and benefits data. This removes repetitive manual effort and ensures consistent data capture across systems.
Any failure or exception during bot execution is logged and escalated through automated email notifications. This allows the operations team to respond quickly and maintain continuity.
A dynamic Excel mapping sheet determines the correct verification method for each insurance, making it easy to add or modify payers without changing the bot’s core logic.
Each verification result is saved as a standardized PDF, named using clear conventions for easy retrieval. Documents are stored in organized folders to support compliance and future audits.
The bots handle multi-factor authentication using secure credential storage and dynamic code retrieval. This ensures safe portal access while maintaining automation reliability.
Benefits
The Takeaway: A Smarter, Faster Workflow
The implementation of the RPA solution delivered measurable improvements in both operational efficiency and accuracy. For example, we added patient balance details directly in the billing notes so the front desk can address balances while the patient is in the clinic. This helps control patient accounts receivable by collecting relevant payments upfront.
By automating the entire eligibility and benefits verification process, the client achieved significant time savings, reduced manual effort, and ensured consistent data handling across systems. The results below highlight the tangible impact of the solution
verified automatically
successfully in UAT
per verification task
post automation
Today, the client runs a faster, reliable eligibility process that frees up staff time, reduces errors, and improves patient communication at every visit.