Claim Processing Automation | Insurance RPA

Claim processing and reconciliation are highly rule-based, stable with structured inputs, making them highly efficient when automated. RPA tools bring quick and accurate automation solutions helping payers boost revenue.

Robotic Process Automation for Third Party Administrators

Which processes do I Automate?

Healthcare Claim Payment from a health insurer to a healthcare provider either directly or via a financial institution (EDI 835) is used to make a payment, send an Explanation of Benefits (EOB), send an Explanation of Payments (EOP) remittance advice, or make a payment and send an EOP remittance advice only.

These simple processes cover a large amount of manual work in reconciliation –

Verification of claims
Matching of claims
Carrying out adjustments
Highlighting disputes
Modifying Patients or Payer Charges

These processes are rule-based, high volume, stable and with structured inputs, making them apt for automation!

An auto-adjudicated claim costs 75% less in processing,
generating over $1 billion savings for $3 billion claims filed/year – Analyst Research

Applications of RPA

Claims reimbursement is the biggest source of revenue for most practices. A RPA tool provides a quick and accurate solution when dealing with volume, complexities of payer contracts, insurance company rules, coding and filing, claims tracking and more.