Can Robotic Process Automation Speed Up Payer Claims Processing?

How can we achieve automation in healthcare claims processing?

Repetitive and tiresome procedures heavily burden the insurance industry. Processing of documents takes ages, affecting the quality of services offered to customers.

The health insurance industry especially faces an enormous bottleneck; payer claims processing. Patients persevere the slow steps of claims submission and have to wait weeks, if not months for claims to be processed.

With over 30% of claims ending up denied, lost, or ignored, you can imagine the havoc inefficiencies wreak on the universal health care efforts.

To mitigate this issue, we can start by speeding up paper claims processing. We do so by leveraging Robotic Process Automation (RPA) for medical claims processing automation.

How can Robotic Process Automation speed up payer claims processing?

An RPA software uses computer vision and machine learning models to automate repetitive tasks based on rules and triggers.

Let’s go through 5 ways automation in healthcare claims processing can be achieved through RPA technology.

1. Automating Data Entry

When a patient seeks medical service in the hospital, they start by booking an appointment with the doctor. 

They fill forms online or by paper and provide their insurance information for healthcare providers to confirm the services needed are covered.

Once the appointment is approved, they begin filling several forms such as health insurance claims, hospitalization claims, and critical illness claims depending on the services they need.

Manually filling forms is repetitive, time-consuming, and prone to human errors. 

According to Becker’s Hospital Review, 80% of medical bills contain errors.

Additionally, not every handwriting is legible, and lack of consistent form formats compromises data quality.

You can use Robotic Process Automation tools in the form filling stage to achieve medical claims processing automation.

Essentially, an RPA program scans required documents, including identity cards and medical certificates, extracts data using machine learning models, and fills claim forms automatically.

Patients will present all required documents, have them processed, and proceed to the next step within a few minutes. Meanwhile, healthcare providers will be free to interact with patients offering more personalized care.

Considering that most patients are unwell when visiting health centers, you wouldn’t want to offer a stressful experience, especially before they receive medical attendance. Would you?

One of the challenges Max Healthcare was facing was processing large volumes of patients’ transactions while ensuring the accuracy of claims. Implementing the UiPath RPA platform reduced claim processing turnaround time by 50% and saved over $130,000 annually.

They also managed to reduce human intervention significantly.

2. Reducing Claim Errors

Insurance claims processing is often marred with many errors. It starts with the payer receiving claims which come in large numbers.

They start scrutinizing the documents one by one, checking for errors as minute as spelling errors. The process is time-consuming and tedious. 

Being human, they get exhausted as time goes by, and their accuracy and speed are negatively affected.

In that physical state, they’ll often fail to see errors or inconsistencies that critically determine the claim’s validity. As such, they provide a convenient loophole for frauds to exploit.

The National Healthcare Anti-Fraud Association estimates that $68 billion is lost to health care fraud annually.

Could this be where your insurance company is losing revenue?

Automation in healthcare claims processing using RPA tools can be a game-changer for you.

As a fully integrated end-to-end solution, RPA uses computer vision technology and natural language processing for data extraction from medical bills and validation based on rules infused through training.

RPA technology comprehends unstructured and semi-structured data and can spot errors and inaccuracies with great ease if well trained. Best of all, it does this with great speed and accuracy.

By eliminating manual verification of insurance claims, RPA allows insurance experts to only focus on claims flagged by the software and complex errors.

An insurance company was overwhelmed by the significant increase of claims in the wake of the Covid 19 pandemic. 

By working with Blueprint RPA service, they implemented an automated document processing solution that reduced errors by 90% and increased claims processing time by 30%.

Ultimately, the company could deliver value to its customers faster in a critical economic period.

3. Tracking Adjudication 

Claims adjudication contributes heavily to the entire payer claim processing time. It involves the reviewing and accepting or denying of claims presented by health care providers

Medical insurance companies begin analyzing claims as soon as they land on their desk. They check for errors, and the slightest inaccuracies such as misspelled words can cause a delay.

Meanwhile, they communicate with the medical provider through remittance advice and remarks codes to get explanations.

If there are inconsistencies between the information provided and the system, the claims will have to go through human intervention, which is frustrating and time-consuming.

So, how can Robotic Process Automation speed up payer claims processing in the adjudication stage?

Medical claims processing automation can overcome this obstacle through auto-adjudication.

According to McKinsey, more than 50% of insurance claims will be automated by the year 2030. Auto-adjudication uses AI-powered RPA software to scan for errors and approve or deny claims provided by healthcare institutions.

RPA technologies can conduct cognitive operations on extracted data through content transformation, which involves making data more versatile and reusable, thus enabling accurate claims validation

Also, through AI-powered chat tools, they can engage in direct conversations with healthcare providers to get information on the go.

By automating interactions, they help monitor the claims processing, increase productivity while not compromising on quality.

Care1st Health Plan Arizona, a healthcare insurance provider, depended on unreliable macros to process new claims and enroll patients.

They implemented RBA software into their claims management system, increased claims they could process from 3 to 20 claims in one minute, and eliminated human errors. In addition, the system became more reliable and efficient, improving the quality of their services.

4. Simplifying Compliance. 

A complex legal framework characterizes the medical insurance industry because of the high stakes involved; health and life.

Compliance covers a wide variety of ever-changing practices affecting internal and external regulations, and most mandates relate to patient information privacy, patient safety, and billing practices.

Observing regulatory compliance is complex and time-consuming. A study by Thomson Reuters revealed that a third of insurance companies spend a day every week keeping track of regulatory changes.

Therefore, they hire experts to study legal mandates and guide the insurance companies to comply with the claims policies. They invest heavily in this because lack of compliance attracts heavy fines.

What if you could achieve faster regulatory compliance with less legal costs?

Using RPA programs to manage medical insurance compliance contributes to automation in healthcare claims processing.

Robotic Process Automation software coded with compliance rules can extract data from numerous sources and aggregate it for efficient regulatory reporting.

By implementing RPA, you can easily monitor content from authoritative compliance regulators and automatically update your insurance company compliance efforts. Meanwhile, you reduce the time required to keep up with regulatory changes.

You can save on resources and dedicate more time to developing forward-looking risk management practices through this claim processing automation technology. 

You can also embed risk management practices across all business processes and drive value.

A home healthcare insurance provider wanted to ensure compliance with HIPAA while simultaneously decreasing dependence on the human workforce. It implemented an RPA model and automated 68% of prior authorization transactions necessary to access sensitive healthcare data.

In addition, requests could be processed 80% faster than before.

5. Payments Reimbursement

Medical bills are often prone to errors, most of which can go unnoticed. A patient in need of a critical medical procedure is briefly hospitalized and treated.

They are discharged, and months later, they receive a medical bill with an array of treatments, some of which are not covered by the insurance policy.

The insurance company manually scrutinizes the bills but often misses out on errors and inconsistencies. Consequently, they end up overpaying.

Manual claims processing is tedious, lengthy, and prone to errors. In fact, like I already stated above, 4 in 5 medical bills contain errors that cost the United States billions in healthcare expenditure annually.

How can you avoid payment reimbursement errors?

You use RPA tools to achieve medical claims processing automation.

RPA tools can speed up medical bills processing using machine learning and artificial intelligence models for data extraction to analyze bills, and validate or invalidate bills based on rule-based instructions.

By delegating manual verification of bills to technology, an insurance company can potentially save on resources and increase the speed and accuracy of bills validation.

In addition, they can review a patient’s payment history and automatically send follow-up requests. 

Ideally, an RPA program with a well-designed workflow system can take full control of bill processing, engage with healthcare providers and keep patients up to date with their bills.

Baylor Scott & White Health, a health system serving over 50 hospitals in the USA, implemented an automated machine learning claims-evaluation system. 

They can now produce 70% estimations without human involvement through this innovation, thus expediting medical bills processing.

The RPA tools also enabled the company to improve pricing transparency for patients.

Conclusion

Medical claims processing is a big concern for patients, healthcare providers, and insurance payers. Traditional claims processing systems were functional when there were no better alternatives.

However, it’s time for them to be phased out and new, more efficient systems implemented.

Can Robotic Process Automation speed up payer claims processing? 

YES!

RPA offers the best alternative to manual processing. Although it can replace some workers, they mainly do away with redundant jobs and offer workers a chance to focus on more productive tasks.

From automating data entry to processing payments, RPA opens up opportunities for insurance companies and healthcare institutions to have efficient workflows and save resources.