Smart Insurance Eligibility Verification System Reduces Eligibility Related Claim Denials By 70%

Industry: Healthcare Provider

• Reduced claims error rates from 2.7% to 1% in just 3 months

• 45 to 26 days reduction in Account Receivables after implementation

• 5100 hours saved annually

• 70% reduction in eligibility related claim denials

Client Overview:

The client is a 180-bed full-service acute care hospital offering surgical and diagnostic procedures. The hospital handles more than 10,000 inpatients annually. 

Issues with front desk operations can negatively impact the rest of the revenue cycle process as the claim makes its way to the payer and adjudicates. From initial contact, this client would manually verify patient insurance eligibility consistently till all verification-related processes were complete and documented. Checking eligibility for each patient meant applying complex business rules for extracting information about co-pays, co-insurance, annual deductible amounts, remaining deductible amounts, etc. 

The Hospital Required An Effective Solution That Could Solve Operational Constraints Of Eligibility Verification

The hospital typically witnessed about 300-450 walk-ins per day. This required dedicated FTEs to do manual checks for each scheduled visit. Utilizing manual resources, the operations team would process patients each day, adding resources as necessary to complete the task.

As with any manual process, accuracy is dependent upon the number of allotted resources and the time each resource is given to complete the task. Faced with a growing attendance issue and a lack of necessary resources, error rates increased and negatively impacted operations throughout the rest of the revenue cycle process. The client sought technical assistance in automating these processes and reducing overall backlogs.

AiRo’s Intelligent Automation Turbocharges Clients' Eligibility Verification Process

AiRo Digital Labs deployed a smart Insurance Eligibility solution to capture information from scheduling assistants or scanned data from insurance cards. The solution uses an RPA bot and can mimic actions performed by a user to automate repetitive administrative and clerical work. These bots work in the background to ensure that predictable, repetitive activities are completed without the need for human interaction. RPA can operate 24 hours a day and complete jobs in a fraction of the time it would take a human to complete. 

During the eligibility verification process, an RPA bot logs in to the payer portal to get the eligibility information and then compares the data with the current requirements and sends the report. This frees up FTEs for higher-value tasks and significantly reduces the A/R time.

Outcomes of RPA Adoption for Eligibility Verification 

• Claim error rates decreased from 2.7% to 1% in just 3 months.

• The number of days in Account Receivables went down from 45 to 26 days after implementation.

• 5100 hours saved annually.

• 70% reduction in Eligibility related Claim denials.

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The AiRo Perspective

AiRo Digital Labs deployed a smart Insurance Eligibility solution to capture information from scheduling assistants or scanned data from insurance cards. The solution uses an RPA bot and can mimic actions performed by a user to automate repetitive administrative and clerical work.