Intelligent Claims Scrubber Solution Helps Insurance Provider Reduce 66% Duplication Of Claims
Industry: Healthcare Payer
50% increase in processing scalability.
66% reduction in duplicate claims.
Management visibility across operations and process performance insights through business analytics.
Client Overview
The client is a highly regulated Medicaid and Medicare Insurer which serves nearly 2.5 million members across 10 states.
In the United States, the speed with which medical claims are processed is critical to the medical billing process. It can save the patient, provider, and insurance time, money, and irritation if the claim is processed swiftly. This is where claims scrubbing enters the picture. Thorough claims scrubbing is an important process that influences whether or not the claim is approved the first time.
Client Sought External Expertise To Automate The Manual Process Of Claim Scrubbing
Scrubbing claims is an essential part of the medical billing process. It saves time, money, and a lot of aggravation. Many types of data from the claims are reviewed and analyzed during claims scrubbing, including:
Data about patients and providers
Insurer information
Medical need
Procedures used by a medical professional to arrive at a diagnosis or treatment
Procedures relevant to age and gender
Medicare, Medicaid, and other healthcare programmers information
The low processing rates and high manual costs of claim scrubbing proved to be a barrier to effective growth. The client wanted to improve claims processing efficiency and auto-adjudication rates with a solution which could integrate with their existing core administration system. AiRo suggested an RPA and ML-enabled solution to automate the time-consuming manual claim scrubbing process.
AiRo’s Solution Accelerates Claim Scrubbing Workflow
AiRo devised a solution that leverages AI technologies like RPA and machine learning to meet the clients changing demands. The solution could accelerate all aspects of the claims process workflow- Data input, Decisioning and Payout. For this the platform aggregates and validates data from various input sources like manual claims entry, electronic claims and direct data entry - membership checks, eligibility checks, entitlement checks etc. Post data processing and validation, clean claims are auto directed into adjudication and problem claims into exception workflows.
AiRo’s Claim Scrubbing Solution Boosted Claim Processing And Reduced Claim Duplicacy by 66%
Automated claim scrubbing using RPA and ML increased management visibility across operations and process performance insights through business analytics. The claim scrubbing software resulted in:
More accurate claims (and fewer denials)
Quicker payments and Faster turnaround
Better provider-payer relationships
The client recorded the following results post-deployment:
50% increase in processing scalability.
66% reduction in duplicate claims.
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The AiRo Perspective
AiRo devised a solution that leverages AI technologies like RPA and machine learning to meet the clients changing demands. The solution could accelerate all aspects of the claims process workflow- Data input, Decisioning and Payout.
