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RPA for Healthcare Providers: Automating Claim Denials Management

Healthcare providers across the country are overburdened with tedious and repetitive back-office tasks. Whether it’s submitting a prior authorization, scheduling appointments for patients, or processing insurance claims—which are just a few of the manual and time-consuming tasks—healthcare providers find themselves having to do more with less due to the increasing needs of their patients. These tasks, along with numerous others, lead to less focus on patient experience, missed revenue, and potential exposure to compliance risks.  

To improve these pain points, healthcare providers are starting to look towards robotic process automation (RPA) to automate back-office and revenue cycle processes. According to UiPath, healthcare is predicted to have a 36% automation potential, which means more than a third of healthcare tasks could be automated. RPA does not look to replace human resources. Instead, it frees them up to spend more time on high value-add tasks, benefiting everyone involved in these strenuous processes.  

Per the 2019 CAQH Index report, prior authorization was the most costly, time-consuming transaction for healthcare providers. Increasing complexities across the industry have made this process feel burdensome for payers, providers, and patients. RPA can simplify this process for healthcare staff by gathering information from payer websites and other systems needed to submit a prior authorization request, and then populate that data with the provider's EMR. 

Appointment scheduling is considered to be a ubiquitous source of inefficiency across the healthcare industry. When a patient schedules an appointment, staff must align the patient’s requirements with doctors’ schedules and availability, and often times must do the same for any equipment required for the visit. RPA can automate the appointment scheduling process, and it can do so while accounting for criteria specified by the patient, such as procedure, location, or simply the first available doctor. RPA can also be leveraged to review patient information in the provider’s EMR and create a referral that can be sent to aid in fixing an appointment with another healthcare provider.


Revenue recovery is critical to the overall financial performance of a health system. According to Becker’s Hospital Review, the healthcare industry nationwide spends roughly $8.6 billion on appealing denied claims, and the average hospital loses almost $5 million in revenue due to denials. Too often is a denied claim the result of a simple data entry error, missing information, or duplicate filing, all of which are largely due to the fact that this process is very manual, and human error is unavoidable. RPA can manage the data entry process for insurance claims, removing human error and dramatically speeding up the process while monitoring it the entire time. Additionally, it frees the human from the same tedious tasks and offers the opportunity for more meaningful work, like researching policies and regulations for more complex claims.


Leveraging RPA, healthcare providers can focus on improving the patient experience while reducing costs and improving efficiencies across the back-office. Automation seamlessly executes on these tedious day-to-day processes, allowing staff to focus on higher value-add tasks, while helping the health system improve the speed, consistency, and quality of the care they provide to their patients.


If you're ready to transform your healthcare organization's operational efficiency with RPA, download this white paper on our approach for automating claim denials for healthcare providers with RPA and contact us to learn about our prebuilt healthcare automation solutions for revenue cycle management.

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