Industry: HEALTHCARE
Department: FINANCE
Process: CGHS/ECHS
Fully
automated
Zero
error rates achieved
Improved
employee satisfaction
Client Overview
Max Healthcare is one of the most trusted healthcare organizations in North India, operating multiple hospitals across the region. As a leading healthcare service provider, they handle thousands of patient interactions daily and process claims through various government schemes, including CGHS (Central Government Health Scheme) and ECHS (Ex-Servicemen Contributory Health Scheme).
The Challenge
Max Healthcare’s finance team was responsible for managing CGHS and ECHS data across their PAN India locations – 12 hospitals for CGHS and 17 hospitals for ECHS. The process required staff to log into government portals using 29 different hospital IDs, manually track claim status updates, download settlement and submission data, extract key claim details, and upload this information into their SQL database. This repetitive and fragmented workflow created operational inefficiencies and increased the risk of errors, leading to inaccurate reporting and missed claim updates.
Key pain points
- Manual login to portals using 29 different credentials daily
- High risk of human error in data extraction and entry
- Missing or unnoticed bills causing revenue leakage
- Longer cycle times and redundant manual efforts
- Compromised data accuracy and security concerns
The Solution
RPATech implemented an intelligent automation solution to streamline CGHS/ECHS claims data processing and query handling.
The customized bot was designed to automatically log into the UTIITSL website (for CGHS) and the ECHS portal using all hospital credentials, track claim status updates, download settlement and submission data, extract required fields, and upload structured data directly into the SQL database.
The solution leveraged RPATech’s proprietary methodologies, including D3O™ (RPA Delivery Framework), AugurD™ (RPA Identification Framework), and MotherBot® (Auto Discovery-Deployment Framework), to ensure optimal automation design and deployment.
Key aspects of the solution
- Automated login process for all hospital IDs across CGHS and ECHS portals
- Auto-download of settlement and submission data
- Dynamic extraction of key claim fields based on status
- Direct integration with SQL database for seamless data updates
- Complete elimination of manual intervention in the process
Results
KPI | Pre-Automation | Post-Automation |
Process Handling | Manual effort across 29 hospital IDs | Fully automated with zero manual effort |
Data Accuracy | Prone to human errors and missing bills | 100% accurate report generation |
Financial Impact | Revenue leakage from unnoticed bills | All bills identified and claimed |
Employee Involvement | Full-time staff for repetitive tasks | Staff redirected to strategic activities |
Risk Management | Limited visibility and control | Complete visibility and control over outcomes |
The Outcomes
- 100% automation of the CGHS/ECHS claims data processing and query handling
- Financial gains through identification of previously missed/unnoticed bills
- Zero manual effort required for data extraction and collation
- Enhanced accuracy in report generation with elimination of human errors
- Improved employee satisfaction by removing redundant tasks
- Better risk management through increased visibility and control over claims processing
