The Client
Our client is India’s leading world-class healthcare service provider, aiming to deliver patient-centric care by providing the highest standards of medical care. Being present in the market for two decades, the client has set its footprints in various parts of India, installing 17 healthcare facilities in PAN India.
The Problem
Our client received transaction details of the claims processed by the Insurance company against the hospital billing amount of the insured patients. The data was received from 25 TPAs with a total of 38 different formats in PDFs and emails. The manual data entry and validation process resulted in piling up a huge volume of data and increased the burden of a delayed claims settlement.
The Solution
RPATech evaluated the client’s current process to understand and design an end-to-end Claims Processing automation solution. The solution was developed to clear the backlog and reduce the TAT in the future as well.
Considering the client’s requirements and challenges, we used our proprietary D3O framework to identify the scope for RPA implementation, analyze the client’s process and design a roadmap.
Our RPA experts developed the bot on the UiPath platform tailored to the client’s requirements. The RPA bot reads the email received from the listed 25 TPAs, downloads the pdf attachment and extracts the required information. It collates the data uploads on the SQL database. Only the claim details received from other than the defined TPAs and formats are passed on for human intervention.
Business Outcomes
Following were the qualitative and quantitative benefits that our client attained with Claims Processing Automation: