THE PROBLEM
Our Client , a mid size healthcare provider, located in the east coast was facing huge financial loss due to denial of claims. Their denial rate was as high as 11%. Too often is a denied claim the result of a simple data entry error, missing information, or duplicate filing, all of which are largely due to the fact that this process was very manual, and human error was unavoidable.
Our Solution
Pursuit started with Setting up metrics for tracking claims and tried to identify patterns in claims that are denied. Post identifying the cause, the claims were monitored and concern areas were identified before final submission. A predetermined checklist was created and RPA BOT was used to monitor outgoing claims based on this checklist. . If an error pattern was detected, the RPA BOT suggested corrective action for the claim before submission There were few claims that could not be corrected, the RPA BOT moved them to an exception flow path, where the claim was queued for further monitoring.
The Outcome
