Challenge:

A leading national infusion therapy provider was throwing bodies at the problem of performing claim status checks and EOB retrieval for hundreds of thousands of claims. The process of searching claims across dozens of payer portals was extremely time-consuming and prone to human error. It was hard to get the team to interpret the data and bring it back to the billing system in a consistent and structured way. As a result, tens of millions of dollars fell through the cracks in unidentified denials and payments, resulting in unnecessary revenue leakage.

Solution:

We built a suite of RPA bots customized to the biggest payer portals to automate the end-to-end process of searching for the claim, matching it to the AR reports from their Advanced MD EHR, retrieving the EOB document, interpreting the data, and posting appropriate action codes in Advanced MD, their practice management system.

National Infusion Therapy Provider

EHR bots integrate Advanced MD with UHC, Availity, Cigna, BCBS, and other payer portals to find additional $42.4M in denials and $10.2M in unposted payments.

I'm really happy with your work and we're moving really fast. Thanks to you, I no longer need to hire for 11 full-time positions. Your work has already more than paid for itself and that's not even counting the benefits of eliminating human error, consistent workflows, and not having to fill previously open positions. Our follow-up used to lag behind 120 days, and now it's down to 11 days or less. I'm super excited about everything. You have a great team!

- SVP, Revenue Cycle

  • Technology: Advanced MD, UHC, Availity, UMR, BCBS, Cigna, and more.

  • Company Size: 500-1000

  • Industry: Healthcare

  • Revenue: $100M+

$52.5M+ in unidentified denials and payments found in just a few runs:

  • Identified $42.4M in missing denials, where an estimated $12M are recoverable.
  • Identified $10.2M in missing payments, with an additional 10% eligible for management fees.

Unparalleled speed and consistency:

  • Processed claims on a rolling basis, at the rate of tens of thousands of claims in days, not weeks or months.
  • Normalized claim status results across a dozen payers.
  • Applied custom business logic to interpret data and post appropriate action codes for the collectors to work.