With a colossal amount of spending since the year 2000, the healthcare industry is now an $18 trillion global economy. Growing at a brisk pace, it is expected to grow at an annual rate of 5.4% in the upcoming years. Though the health sector is growing rapidly, it is dealing with the critical issue of costs that are spiraling out of control.

Technology is perceived to be a stepping-stone towards optimizing the costs and Robotic Process Automation (RPA) is a new path breaker to achieve it in less time. Organizations have identified key areas where RPA is seen as the final frontier for streamlining healthcare processes.

Let’s explore the above use cases in detail that are making a real impact in driving efficiency in the medical sector.

1. Fastening Insurance Eligibility check with Digital Enrollment

Citing an instance on the visit activity to a care center, there are two scenarios:

• The patient is generally provided various forms to fill the same information – demographic background, medical history, etc. which takes time. On multiple visits to the medical center, the patient needs time to fill up the form again and give past medical information.
• After receiving the filled form, the attendant enters the information in the system i.e. Electronic Health Record (EHR) by scanning or inputting it manually which may result in duplication errors.

Implementing software robots in such cases expedite the data entry process with greater accuracy and, extract stored patient data from its database in emergencies. It has the capacity to upgrade patients’ scheduling efficiency with the amalgamation of information from different sources.

Further, RPA solutions can verify patients’ health insurance eligibility with retrieved patient coverage data from partnered insurer’s website based on their service agreement. Technology Service Providers (TSP) can automate the end-to-end process of data entry/retrieving, appointment scheduling/cancelling, checking for insurance eligibility, etc.

• Putting RPA into action, a leading medical supplier automated the retrieval process of client insurance data from insurer web portals. This helped them in the verification of insurance eligibility of 1k patients daily and saved $1million annually.

2. Simplifying Claims Adjudication

The rise in treatment costs, dynamic regulations, and high-level competition in the market are forcing insurers to change their operations and reduce costs to stay competitive. Automating claims adjudication can assist the payers in settling the patient claims, curbing overhead & administrative charges in minimal time.

The user-friendly automated approach assists in validating information (For e.g. – checking duplication errors) and adjudicates the claim as per the patient’s entitled plan. It is extremely critical to undergo the claims adjudication process to ensure that no false claims are accepted.

• A major health insurance firm enabled efficient administration of rising claim volume by integrating ‘Trizetto QNXT solution’, enhancing auto-adjudication from 75% to 83%.

3. Modernizing Healthcare Billing with Automation

Billing efficiency can be enhanced with the implementation of RPA in data digitization and accounts payable processes. Shifting their administrative work towards digital, healthcare firms can significantly curb labor and financial resources’ costs. Software robots help in recording the changes and easily adapt to the occurrence of every billing cycle.

• Boston Scientific teamed up with Automation Anywhere to enhance their customer service covering four processes including billing automation, saving $240k annual costs.

4. Ensuring Efficient Administration of Provider Credentialing services

Adding a new provider to its network is critical for a payer as it involves the validation of the provider’s information, called provider credentialing. With multiple unavoidable steps, the provider authentication process is time-consuming which comprises enrollment forms, adding & validating data in the payer’s system, etc.

RPA in healthcare helps in accelerating the registration and validation process of a new provider into the payer community with the available information. Automation of such manually intensive work can significantly help in saving time.

• WPS Health Solutions integrated Naviant’s OnBase Case Management for enrolling, credentialing, and onboarding providers in just 17 weeks speeding up the process by 72%.

Deploying Robots-as-a-Service is Key to Enhance Sales Enablement

The automation era holds an enormous opportunity for the entire care sector with new mechanisms giving outstanding patient outcomes and unlocking the economic path to success. As the number of people is constantly growing in the health ecosystem, RPA plays a crucial role in enhancing interoperability services among providers, payers, and patients.

Technology Service Providers (TSP) are providing Robots-as-a-Service (RaaS) to cater to the $18 trillion healthcare ecosystem. Providers eyeing for sales enablement are partnering with TSPs that assist them in:

• Streamlining EHR processes for an optimized and flawless workflow experience
• Checking patient eligibility for the health insurance saving millions of dollars
• Enhancing quality of patient care with automated appointment reminders/follow-up sessions
• Improving efficiency with stronger billing cycle and reducing operational costs
• Managing provider credentialing and claiming processes in less time

Draup, a sales intelligence-based solution provides TSPs with insightful data on automation needs in healthcare organizations. Gathering these data, TSPs can pitch their sales offering around automated healthcare solutions to prospects leading to successful partnerships and gain meaningful returns.

What are the possible automation opportunities among payers & providers in the healthcare ecosystem? Would you like to know how these opportunities are leading to sales enablement? Please drop us a note at info@draup.com to know more about it.