Client’s Profile

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.

Client’s Case

Being one of the largest hospital networks in North India, the client interacts with many patients and handles droves of patient documents that need to be processed daily. Every record: customer details, claims processing, and government health schemes, must be accurately chronicled, requiring higher efficiency. However, the client’s case was that they used conventional methods to reconcile and collate patient data into the database, which was arduous, time-consuming, and open to errors.

Client’s Alliance with RPATech

The client was not exposed to the real-time benefits of RPA and the key features it offers. However, they were given visibility to the process implementation and outcome during the meeting with our CEO and Founder, Alok Mani Tripathi, at an event.

 

After knowing the impressive benefits and key features of RPA, the client immediately partnered with RPATech, based on our demonstrated technical expertise and experience in consulting across industries.

“During our discussion with RPATech, they were able to demonstrate their technical superiority over the competition. Also, their understanding of RPA as the technology was far ahead of other players. Credentials of Alok, who is the founder of RPATech also gave us confidence about our engagement.”

Process Overview

The client receives details of claims processed by the Insurance Company against the hospital billing amount claimed by the insured from 25 different TPAs. And each TPA has multiple formats, resulting in more than 25 unique claims formats to deal with. TPAs send settled claims details via email to the hospital with a PDF attached or share details in the email body.

 

The details mentioned in 14 fields are copied and pasted into the SQL database. The data extracted from the formats include:

  • Customer Case Number (CCN)
  • Patient Name
  • Insurance Company
  • Name of the hospital (where the patient stayed)
  • Date of Admission
  • Date of discharge
  • Amount paid by the insurance company
  • TDS
  • Disallowed amount
  • Reason for disallowance
  • Discount
  • NEFT/cheque number
  • NEFT/cheque date

(Field’s Nomenclature varies according to different TPA formats).

Client’s Challenges

The client was dealing with a considerable amount of data. Additionally, their claims process was manual. However, the client tried using generic software to ease the pain but in vain.

 

The client attested that dealing with such a large amount of data was humanly impossible. Their staff often missed entering data accurately and efficiently, resulting in missing claims which impacted the business’s bottom line. Further, the client expressed that even though people would try to reconcile the data manually, it would still throw up errors.

 

Moreover, it is time-consuming for the staff to work-rework and manually reconcile records. Therefore, the manual Claims Process was a tall order for the client.

The Ask

The client’s primary requirement to automate their Claims Process with RPA was to dispose of the missing claims, improve process efficiency, and implement a coherent system.

 

Their goal for the Claims Processing automation included the following:

 

Short Term Goal

Long Term Goal

Reduce errors

Reduce turnaround time

Revenue realization

Building trust with patients

Secure data sharing

Our Approach

Considering the client’s requirements and challenges, our RPA experts used our domestic approaches: D3O™, AugurD™, and MotherBot®, to identify the scope for RPA implementation, analyze the client’s ‘As-is’ process and design a ‘To-Be’ roadmap.

 

Our RPA experts authored the Bot on the UiPath platform tailored to the client’s requirements. The RPA Bot reads the email received from listed 25 TPAs with multiple formats, extracts details from 14 fields, collates the data into the SQL database, saves the data and closes the application. If the Bot receives claim details from other than defined TPAs and formats, it moves them into the exception queue for the human to handle it.

"We deal with so much of data here in our system, every patient may have hundreds of interactions or episodes within a day. So, to reconcile all the data is really a tough task. With RPA we’ve been able to do things which would not have been humanly possible to do."

Value Outcome

Following were the qualitative and quantitative benefits that our client attained with Claims Processing Automation:

 

  • By automating the claims processing, the client was able to slash turnaround time by 50%.
  • RPA helped them completely secure their data: 100% data security.
  • Within a few months of RPA implementation, they were able to realize revenue 100%.
  • Outstanding claims of Rs 1 Crore were recovered within 12 months.
  • Error rate came down to 0%.
  • Business decision-makers were able to have a 360-degree view of the process and gain control over the operations.
  • Receiving daily reports in the email before the client could arrive at the office, giving them visibility into what is happening and access to where is the problem lying.

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