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Automating Claims Processing​ with RPA

Region: USA

Industry: Healthcare

Client Overview

The client is a leading provider of world-class physical, occupational, and hand treatment in the United States.

Process Type

Healthcare Claims Processing

A major US healthcare provider needed a way to process patient claims efficiently while also reducing human error.

JOLT developed and deployed 6 automations that collected and validated the patient data across multiple systems of record and processed the patient transaction in the applications of record.

The customer is the Northeast's premier supplier of world-class physical, occupational, and hand therapy, operating 200 outpatient physical and hand therapy centers in the US. Their certified Physical Therapists create individualized treatment programs for each patient, using the latest cutting-edge technologies and practices to keep people performing better than they have in the past. They are prepared to treat a variety of conditions with an emphasis on surgical and non-surgical sports and orthopedic injuries. Innovative approaches for injury recovery, pain relief, and ongoing fitness and wellbeing are available through their programs, which include a range of fields such as Pre-Operative Preparation, Injury Prevention, Aquatic Therapy, and more.

ClaimsProcessing_RPA Success story

The organization needed a way to process patient claims quickly and reduce human error in the claims process. The data validation required across disparate systems, paper forms, websites, and applications of record made the process disjointed and slow. At the same time, the websites, and applications the client leveraged for patient eligibility and benefits validation changed monthly.

The client started their RPA journey in early 2019, purchased UiPath, and engaged with a system integrator for strategy and implementation of the Claims Processing Automation for the Insurance Eligibility & Optum Authorization process.​ The original system integrator’s strategy was flawed and was not driving any results, 6 months passed, and there were zero automations in production. C-level executives were not seeing any return on their investment and the idea of killing the entire RPA project surfaced.

RPA Rescue Mission

Team JOLT stepped in to develop and deploy a series of six automations that coordinated the data pulls by patient or group and validated the data by performing the human actions to collect website-based data for comparison. After 2 weeks of initial assessment, JOLT deployed a team of 24 highly qualified, UiPath certified resources, to work with the client team to finalize requirements for redeploying the processes (carriers), translating the functional process documentation into a robust technical design and Solution Design Document (SDD). Within 12 weeks JOLT deployed 9
Processes in Production. 

Automating Claims Processing


The Insurance Eligibility & Optum Authorization process required data collection, comparison, and validation, before processing the patient transaction in the applications of record. Any record that was not able to be validated generated an “exception” to the logic rules used in the automated process. Exceptions were delivered to the humans for quick verification.

The monthly application and website changes forced the client to be very reactive in transaction processing, but automation was able to scale to help the client through the changes. Our Managed Services team was engaged to receive exception alerts through the autonomic monitoring system that identifies business and application exceptions in transaction records and queues them up to the Robotic Operations Center's development team through incident management to adjust automation rules or logic, enhance the automation where needed, or engage the client application development team to work through a data structure or application changes.

After deploying 9 automation processes into production within just 12 weeks, JOLT continues to support and maintain these automations in a managed Robotic Operations Center, providing control, monitoring, incident management, release management, bot healthchecks, and performance reporting. Most recently, the suite of dispatcher, scraper, and processor robots for the healthcare client was enlisted to process end-of-year eligibility checks for 5500+ patients, expediting a process that would have taken significant manual labor to accomplish. In just 72 hours starting December 29th, the automation checked the records for over five thousand patients, making sure the patients could continue treatments and receive benefits without interruption by January 1st, 2021.

BY THE NUMBERS


$570,000​

Estimated savings in 2020.​


Eliminated Outsourced Labor​

Reduce offshore manual labor ($5/transaction).​

What comes next?

 

JOLT continues to solution additional automation processes that add value to the client's business, providing support of the automations in production from our Robotic Operations Center, while at the same time, continuing to assess more high ROI process candidates for automation to keep scaling the benefits of automation across the enterprise. 

 

To learn more about how RPA and JOLT can help your business start its digital transformation journey, contact us for a complimentary assessment call.

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