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Featured Use Case

Medicaid Billing

Published: Friday, April 9, 2021

Here's an example of one of Simple Fractal's RPA bots at work processing a Medicaid claim. As you can see, an RPA bot can replicate a human's interactions with an online portal in a fraction of the time.

The Challenge

Submitting and posting Medicaid claims requires a tedious process that consumes a tremendous amount of internal resources. Under this system it can be very difficult to:

  1. Eliminate costly mistakes

  2. Maximize employee satisfaction

  3. Avoid denials and subsequent revenue gaps

What’s so hard about Medicaid claims?

Handling Medicaid claims and posting payments often requires a different process than for commercial payers, as Medicaid claims frequently involve special codes, modifiers, and portals. This leads many healthcare providers to designate a custom protocol solely for this one payor.

The teams handling these claims often have to:

  1. Scrub claims with precise and consistent audits

  2. Submit claims manually

  3. Attend to detailed edits and corrections

  4. Gather reporting insights on your billing

  5. Perform double data entry in multiple systems

These manual processes are highly error-prone. In addition, the work can be so undesirable for employees to perform that it can lead to backlogs, revenue gaps, and even staff turnover (which means even greater costs to recruit and train new replacements). Another downside is that in this model, there are no economies of scale – if you process twice the volume of claims, your costs double.

The Solution

These tedious yet critical administrative “chores” are a perfect use case for RPA bots. Autonomous bots can:

  1. Perform thorough and accurate audit checks

  2. Submit a huge volume of claims automatically

  3. Log in to varied external systems to gather information

  4. Post the information error-free into other applications

  5. ...and much more.

The great thing about bots is that they don’t care how tedious the task is. They’ll do it the same way every time with maximal precision and accuracy, regardless whether they’ve done it once or a million times. When it comes to complex and repetitive processes like Medicaid collection, bots can save your organization time and money, while at the same time improving the satisfaction of both your clients and your own workers.

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