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Case Study: Healthcare Provider

Automation of Eligibility Verification helps in reduction of A/R from 45 to 26 days

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A Multispecialty healthcare provider implements AiRo’s automated Eligibility Verification Solution for speeding up Revenue Cycle Management

Administrative burden is one of the biggest challenges for Healthcare Providers. A lot of people work “behind the scene” to deal with multitude of data on insurance coverage, coding, billing and more. Although these resources are always busy at work, they never actually speak to a patient or increase the quality of patient care. According to a study, in the United States, the administrative costs of care account for 8% healthcare spending.

Between the 6 locations, the healthcare provider witnessed about 300-450 walk-ins per day and about total 6000 visits per week. Walk in patients would have to sit and wait for long time while their insurance was checked.

Checking eligibility for each patient means applying complex business rules for extracting information about co-pays, coinsurance, annual deductible amounts, remaining deductible amounts, etc. This is a tedious and time-consuming process, prone to manual errors. However, performing eligibility verification is vital for healthcare providers to submit clean claims. It avoids claim re-submission, reduce demographic or eligibility related rejections and denials, increase upfront collections; leading to improved patient satisfaction. Incorrect insurance information results in delayed payment at best, or denial at worst, impacting Revenue Cycle Management.

Smart Eligibility Verification Solution

Eligibility verification is the process of checking a patient’s active coverage with the insurance company and verifying his or her claims. It is important to collect accurate information reading insurance coverage and the patient’s responsibility to pay for healthcare services. Incorrect information can lead to payment delays or claims denial. Automating this task not only helps the healthcare providers with revenue cycle management but also allows them to focus on patient care.

Converging digital technologies such as OCR, RPA and ML modelling, AiRo Digital Labs has developed a unique solution to reduce human intervention. After capturing information from scheduling assistant or scanned data from insurance card, the system verifies patient insurance coverage details. In case, the patient had scheduled an appointment in advance, after verification, the system sends out emails or notifications for providing missing information. While automating patient intake tasks- checking if a person is already a patient in the electronic medical record, registering the patient, and selecting a printer for label creation, the system completes the tasks in average 15 secs versus the 2-3 minutes it took a human. . Automated generation of HIES (Health Insurance Eligibility Screening worksheet), based on income, number of applicants, family size; Auto colorchanging of data-fields of a case helps business users to identify important information in an application. The updated information is finally stored in the billing system for future references.

Capable of running 300-500 records per day without the need for human interaction, eligibility-related claims denials reduced by 70%. Healthcare provider now gives their patients accurate eligibility data sooner, improving patient satisfaction and streamline revenue cycles by submitting cleaner claims to health plans. Within a quick span of time, the client reached an average monthly recovery rate of $30,000 – more than double of its initial target.

Additionally, the employees that were doing that work manually were moved to more patient-centric roles, increasing employee satisfaction. Shorter wait time for walk in patients also meant increase in patient satisfaction. By turning to automated eligibility verification, the client streamlined its operations and managed to enhance the bottom line.

Today’s Scenario

AiRo Digital Labs can help companies increase their registration data accuracy, complete insurance eligibility verification, automate pre-authorization screening, estimate patient’s financial responsibility, validate patient’s identity and help patients who are unable to pay look into financial assistance programs. With more than 20+ modules for automating revenue cycle management, AiRo enables its clients to achieve strategic and financial objectives in today’s competitive environment.


About AiRo

AiRo Digital Labs is an award-winning Chicago-headquartered, Digital 2.0 Consulting firm, with expertise in business transformation through digital convergence of Cognitive Automation, Machine Learning, Voice technology and Industrial IoT. We are strategic advisors for digital future in industries such as Healthcare, Pharma and Life Sciences, Manufacturing, Hi-tech and Retail / CPG. With an agile and collaborative approach, we apply digital convergence to enable sustained business advantage across the 4 dimensions of –cost, speed, accuracy and customer experience.

The AiRo Innovation Factory has developed award-winning solutions to solve everyday business challenges.. Learn how AiRo helps clients on their digital transformation journey at www.airodigitallabs.com


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