RPA in Claim processing reduces Claim Denials

Jan 15, 2018 Sandeep M Somashekar

Revenue Cycle Management (RCM) companies face numerous challenges, including claim denials and cost to collect. It is estimated that up to 40 percent of medical bills contain errors and a report by Advisory Board states that 90% of claim denials are preventable and can be corrected for payment. Claim denial management is a big opportunity for Providers to reduce their Cash Conversion Cycle (CCC).

Reducing claim denials requires a multifaceted approach involving –

  • Record – Setup metrics for tracking claims, identify patterns in claims that are rejected or denied.
  • Root Cause – Understanding and identifying the cause of claim denials
  • Monitor – Identify the emerging patterns in denials and create check lists to verify the identified concern areas prior to claim submission

RPA Can Reduce Claim Denials

Robotic Process Automation (RPA) is a solution to automate rule- based manual tasks and this works in claim processing automation. An RPA BOT can monitor outgoing claims based on a pre-determined checklist. If an error pattern is detected, the RPA BOT can take appropriate corrective action for the claim before it is submitted. For claims that cannot be corrected, the RPA BOT can move them to an exception flow path, where the claim can be queued for manual intervention and correction.

Advantages of RPA in claim processing

  • Faster – As the monitoring is done by an RPA BOT, it is faster than manual verification of checklists.
  • Simple – Unlike traditional IT applications, adding additional logic into an RPA BOT is easy and in some cases, business teams can quickly make the changes as new patterns emerge from the Record and Root cause
  • Free up Human Talent – Screening for known patterns of claim denial done using an RPA BOT, saves on manual effort
  • Error Free (High Quality) – RPA BOTs follows the rules ‘to the T’ and performs the programmed tasks meticulously, resulting in accurate throughput.
  • Save time – An RPA BOT ensures error-free claims are sent for processing, reducing claim denials and in turn re-work.

Our delivery team has the added benefit of a clear understanding of US healthcare rules and regulations, alongside specialized RPA engineers experienced in building and deploying BOTs in various parts of Revenue Cycle Management (RCM).

Sandeep M Somashekar

Sandeep heads the Robotic Process Automation (RPA) practice at iNatrix. He has worked on a wide range of technologies such as embedded programming, OS internals, and latest web technologies. In his personal time, he enjoys cycling, and reading non-fiction.