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RPA & AI and Health Insurance Eligibility

December 30, 2021

The US healthcare billing system needs a digital transformation to cut operating costs and meet the increasing workload. 22% of submitted claims are rejected, and 40% aren't resubmitted. 65% of denials are never contended for, and 10% of claims aren't correctly paid. Checking plan benefit eligibility and insurance verification is vital to prevent these errors from reoccurring. Performing medical insurance eligibility and checks for patients is the first step in processing medical billing. Errors in insurance eligibility verification can increase treatment costs and deny claims. Health insurance verifications depend on treatment, diagnosis, and coverage. Checks include the type of coverage and plan details, referrals, preauthorization, plan exclusions, and payable benefits. Most of the time, these checks are all completed manually and are very prone to errors and inefficient.

RPA, Robotic Process Automation can automate insurance verification and perform preauthorizations for patients. Patient insurance eligibility verification completed through Robotic Process Automation results in decreased effort and time, increased authorization and approvals, decreased billing cycles, and increased staff productivity.

Decreased Effort and Time- Automation takes on all the work usually done manually by staff. Automation checks all patients' eligibility and frees up time for the team to focus on other tasks that must be completed manually.

Increased Authorization and Approvals- Claim authorization and approval rates increase substantially since health providers and clinics complete tasks correctly. Fewer errors are made through automation in the medical insurance verification process.

Decreased Billing Cycles- Gatekeeping is completed by automated insurance checks by automated robot processes resulting in reduced billing cycles and improved approval times.

Increased Staff Productivity-Staff can focus more of their time on contingency issues and more productive work that needs human touch rather than sitting on the phone verifying insurance for hours out of the day.

By automating medical insurance verification processes, operational costs are drastically reduced. RPA also applies AI to get verification forms and correctly check insurance benefits sent to medical billing systems. Handwritten eligibility forms can be converted to digital data using AL. This data can then be used to verify eligibility for a patient and then be sent to the practice's medical billing system to complete other processes such as CPT, ICD coding, claims submissions, payment posting, and patient demographic.