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Automated Validation Process

Automate the eligibility determination process

Challenges

  • The client had a lot of manual intervention for their claims administration process which they wanted to automate.
  • They wanted to automate the eligibility determination process and also needed customization of their HIM system to have reports and integration with the mobile app.

Solutions

  • We implemented 20+ process robots using UI Path for automating manual routine tasks in-patient eligibility and claims management.
  • Built robots to extract patient eligibility details from Medicaid
  • Automated fetching latest claim status
  • Created an FHIR server for electronic transfer of data through secure API’s
  • Created an accreditation mechanism for secure transfer and use of data elements
  • Customized the Legacy app for HIMS to add reporting capabilities
  • Developed Mobile app for appointment scheduling and tracking of patient information

Tools & Technologies

UI Path, Microsoft .Net, SQL Server, FHIR

Key benefits

  • Saved about 90% of the manual effort
  • Robots produce consistent highly efficient operations & customer satisfaction
  • Increased processing capacity by 5 times when compared to manual execution for eligibility check and claims administration
  • Reduced customer service center calls by 60%