Using RPA for claims processing with health agencies

Written by StateScoop Staff

State and local authorities are still feeling the strain on state health services from the COVID-19 pandemic – especially with regard to processing applications.

While the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) created a reserve for state, local, and tribal governments to cover the cost of screening and treating uninsured citizens, it also created payment channels that differ from differ from normal daily demands. Errors with new coding requirements resulted in a mountain of backlog claims.

Read the full report.

Because of this, many government health agencies have focused on RPA (Robot Process Automation) tools to help manage the growing pile of documents.

According to a new report produced by FedScoop and signed by Blue Prism, Bits In Glass and Red Hat, RPA automatically flags mis-coded claims, verifies registration status and benefits, scans forms, and submits claims to the correct payment channels.

By quickly automating manual, rule-based back office administration processes, RPA relieves overloaded administrative staff in an already overloaded system. The new report delves deeper into the benefits of RPA technology.

Unprecedented demands during the crisis

When the pandemic hit last year, millions of Americans lost their jobs and caused citizens to seek government assistance. According to Anna Twomey, Senior Solutions Advisor and Healthcare Solutions Architect at Blue Prism, this surge in claims from Medicaid and Medicare caused claims processing to be disrupted, especially in states that still depend on legacy IT solutions and manual processes

She stated that, given these delays, it appeared to the outside world that the money was not there, despite the fact that Congress had provided funds through the CARE law to assist.

With claims management still using manual processes, there is a big backlog when there is peaks in demand, said Josh Painter, RPA consultant at Bits In Glass, Blue Prism’s integration partner.

“These backlogs can be resolved when Blue Prism’s automation platform takes action on a document and moves it into a system for reviewing, processing, or submitting refunds. It’s an easy way to make a huge impact on the business, ”he said in the report.

IT executives in several states were quickly looking for RPA as an affordable and secure solution for handling sensitive medical information, Twomey said in the report. Currently, Blue Prism’s RPA software platform is fully embedded in approximately 10 states, including New York, California, Georgia, and Texas.

Long-term benefits for RPA implementation

The report looks at several benefits of using RPA, including reducing waste, protecting against fraud, and better streamlining workflows. According to Twomey, automation helps, for example, to reveal gaps in processes that previously created invisible waste.

“You see people interacting with what you thought was a well thought out process. Instead, there are loopholes in places that cause waste, loss, or fraud. This is one area where RPA can be used to reduce risk, ”she said.

The report highlights other advantages of RPA over traditional computerized workflows, including:

  • The speed at which the organization can obtain or disseminate information.
  • The ability to accurately capture information to shed light on fraudulent activity or waste.
  • Process high volumes of work.

To ensure that RPA works seamlessly in the system, Blue Prism, their integration partner Bits In Glass and Red Hat worked together to develop a connected healthcare solution that completes the data transformation for reliable and automated reimbursement. This also ensures the interoperability of RPA, helps reduce delivery errors, and extends the reach of RPA staff.

The ability to automate the processing of thousands of claims and other documents significantly reduces the burden of redundant employee work. Patients, doctors, clinics and hospitals who need it get their money back faster.

In addition to handling claims, Twomey and Painter describe other use cases that they support their partners in implementing RPA. This includes reducing the number of no-shows at appointments and using patient records for prevention and predictive modeling of existing health problems.

Read about the fully integrated, secure, and automated claims handling solution that enables patients and providers to handle claims faster.

This article was produced by StateScoop and sponsored by Blue Prism, Bits In Glass, and Red Hat.

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Automation, Bits in Glass, Bits in Glass 2021, Blue Prism, Blue Prism 2021, Digital Transformation, Fraud Detection, Healthcare, Healthcare, Healthcare IT, Medicaid, Medicare, Red Hat, Red Hat 2021, Robotic Process Automation (RPA), Special Report , Sponsored content

March 30, 2021