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HEALTHCARE

The Application of RPA in Healthcare Revenue Cycle Management

The Challenge

Agents of a leading U.S. revenue cycle management (RCM) service provider were manually logging into healthcare provider portals to check patients’ eligibility and benefits for upcoming appointments. Accurate confirmation streamlines claim submissions and health plan reimbursements. However, with more than 120 provider portals changing every quarter and agents expected to be familiar with each of them, the verification process was complex.

The provider’s existing eligibility and benefits confirmation process involved more than 250 complex business rules. Data had to be extracted from more than 35 fields pertaining to co-pays, co-insurance, annual deductibles and remaining deductible amounts. For appointments made on short notice, these tasks had to be completed within a day. This tedious, time-consuming process was prone to errors. It also risked patients receiving incorrect information and providers submitting inaccurate claims that eventually would be denied.

Our Approach

Cognizant healthcare team designed a robotic process automation (RPA) solution for the RCM service provider’s complete eligibility and benefits verification process. It includes 23 software bots running 22 hours a day, five days a week.

The automation process pulls patient appointment lists from healthcare provider portals across various locations, prioritizes these appointments, extracts appointment details by accessing two different applications and 14 screens, consolidates output reports and confirms patients who are eligible for benefits. The bots also validate and update eligibility and benefits details in each practice’s portal.

RPA Improves Eligibility Verification Process

Cognizant helped the RCM service provider automate its benefits and eligibility verification process using RPA. The provider has improved its customer service and capacity for growth by minimizing costs and saving 17,000 hours annually.

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5,000

transactions processed per day

100%

accuracy

17,000

hours saved annually

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