The client is a162- bed hospital that offers a vast array of healthcare services, with an emergency department treating more than 50,000 patients annually.

For existing patients, the FTEs of the provider would manually verify details such as payable benefits, co-pays, patient policy status, type of coverage plans, etc., from multiple tabs. Similarly, to fetch the data for a new patient, the provider front desk staff needed to visit several sites for payers, resulting in an additional waiting time of 15-30 minutes.

The number of allotted FTEs and the time each FTE is given to complete the work determine the accuracy of any manual procedure. The provider saw error rates go higher as a result of a rising attendance problem and a lack of sufficient resources. This significantly impacted patient satisfaction with the service.

AiRo Digital Labs was contacted to provide a solution to the client's operational constraints to reduce their front desk challenges. As a result, AiRo developed a solution that uses RPA and OCR to collect eligibility information and up-to-date benefit levels from payer sites.

The Client Needed A Solution That Would Increase Accuracy And Efficiency In Patient Eligibility Verification

In the claims filing and reimbursement process, accurate eligibility verification is crucial. However, the team’s efficiency was severely affected by the increasing volume of work they were processing through manual processes. By manually cross-verifying the details with the payer portal, the team had to check the eligibility of hundreds of patients for scheduled visits on a daily basis. This tedious process resulted in longer patient wait times and huge backlogs for Hospital FTEs. The client was looking for a solution to automate the eligibility verification process in real-time to reduce errors and wait time for eligibility verification.

AiRo’s RPA And OCR For Automated Real-time Eligibility Verification Wins Client Confidence

AiRo Digital Labs was contacted to provide a solution to the client’s operational constraints to reduce their front desk challenges. As a result, AiRo developed a solution that uses RPA and OCR to collect eligibility information and up-to-date benefit levels from payer sites.

The bot is programmed to extract appointment details from the provider API, send emails, and check for patient coverage information from various payer websites (mentioned by the client).  The solution uses Abbyy Flexicapture (OCR) to retrieve the necessary information if the data is available in pdf format.

Automated Real-time Verification Gives Provider The Required Support To Streamline Operations

Historically, manual verification has been providers’ responsibility on the front lines. This indicates that a hospital staff member is in charge of confirming the patient’s eligibility. This entails contacting the insurance company and accessing several insurance portals to ensure that the information provided by the patient is accurate and that the treatments requested are covered.

The hospital personnel can better manage and utilize their time with automated patient eligibility checks. As a result, they can focus on more patient-critical duties instead of wasting hours of their day searching for payer information. In addition, automated technologies ensure that your team gets access to the data they require immediately.

With AiRo’s Automated Real-time Verification system, an automated patient eligibility check is performed at check-in. The check-in and invoicing processes are streamlined when this information is automatically available at the visit’s start. Providers can proceed with their scheduled visit once coverage has been validated.

If a patient’s visit is not covered by insurance, they can find out how much their appointment will cost them out of pocket. This offers transparency in the billing process, which patients appreciate from their doctors.