Client focus
Client provides practice management services to independent physician-owned practices and small-mid size hospital groups. It offers end-to-end RCM services to manage its revenue cycle operations including patient registration, insurance verification, billing, and medical documentation.
Challenges
- The client wanted to automate certain processes across pre-authorization and patient medical record submission.
- The pre-authorization process is highly repetitive and lot of manual effort was needed to get the patient details and check for status of authorization whether it is pending for approval, approved or declined.
- Patient medical record submission was another painful task that involves a complicated process of getting the patient data from billing system, medical records from providers EHR system and then sending it to the Payer for claim settlement. This is cumbersome process involving multiple interactions with virtual and Citrix environments.
Solutions
- Cognine has implemented process automation using Blue Prism.
- The bot automatically logs into the payer portal, feeds in the the patient data to get the latest information of claim status. The bot also extracts the information from hand written documents and feeds in the key information.
- For the claim submission, the bot interacts with billing system eCinicalWorks, EHR system Cerner over virtual environments and extracts all the necessary information for filing a claim to the payer. From getting the data to updating the status in the billing system and interaction with EHR and printing the documents, the bots works un-interrupted with manual intervention.
Key Benefits
- Increased task completion rate, reduced error rate and highly efficient operations that cut down manual intervention to near zero which was earlier performed by 2 FTE.
- Expansion of operations to multiple states and on-boarding more providers became much simpler.