AiRo’s Intelligent Automation For Denials Management Helps Healthcare Provider Achieve More Than 90% Accuracy In Claims Identification
Industry: Healthcare Provider
Client’s Overview
The client is a Multi-speciality Hospital that employs nearly 2000 healthcare professionals. Specializing in Cancer, Cardiac, Neurosurgery, Surgery, Electrophysiology, Orthopedics, Primary care and urgent care.
One of the most crucial aspects of the healthcare Revenue Cycle is denial management. With nearly 2000 healthcare professionals the client was serving a large number of patients. But due to an inefficient denial management process, the hospital was losing a significant amount of revenue every year.
Manual Denials Management Process Created Huge Backlogs and Delay in Claim Resubmission
The Hospital was losing on average, 5% -10% of claims annually. Moreover, approximately 70% of claims denied were not resubmitted on time to payers for reimbursement as the Hospital was handling the entire process manually.
Due to these roadblocks, the hospital faced a significant loss of revenue and a poor patient experience. The healthcare provider wanted to concentrate on the root cause and denial avoidance in order to maintain a healthy cash flow and increase overall patient satisfaction and service.
AiRo’s Suggested Intelligent Claims Denial Solution To Streamline Claims Denial Resubmission And Increase Cash Flow
Claim denials are a common problem for health care providers across the United States. Employees encounter less arduous and error-prone manual labor when they use automation in the denials management process.
A targeted RPA deployment would maximize insurance provider reimbursements and reduce or avoid claim denials, allowing health organizations to enhance their bottom line by recapturing revenue that would have been wasted and freeing up employees' time for other value-add duties.
AiRo deployed an intelligent automation platform with machine learning capabilities to streamline the denial management process. The platform uses a learning module that tracks the information on denied claims and provides analytics to improve claims submission. For this, the platform uses OCR to extract patient data from the EOB, and map denial codes with a database for description. The data is then verified with the chargemaster, EHR, and code databases. The clean claims are then resubmitted to the clearinghouse. In addition to verifying and resubmitting the claims the platform also inputs the data to the learning module after redacting patient data.
The client noticed the following benefits post-deployment:
>90%+ accuracy in claim identification
200% Increased flexibility to incorporate additional claims volume
>1000 Claims Backlog cleared within a month
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The AiRo Perspective
AiRo deployed an intelligent automation platform with machine learning capabilities to streamline the denial management process. The platform uses a learning module that tracks the information on denied claims and provides analytics to improve claims submission. For this, the platform uses OCR to extract patient data from the EOB, and map denial codes with a database for description.
