BOT for Eligibility Verification

 

Background:

The medical practice, serving a large patient base, faced the challenge of manually checking the eligibility of patients. The traditional process was time-consuming, error-prone, and often led to revenue loss due to inaccuracies in copays and deductibles.

Objective:

Implement a Smart Automation system that could swiftly verify patient eligibility, fetch copay and deductible details for each scheduled appointment, and alert the staff regarding any discrepancies.

Solution Implemented:

Rekha Tech’s Approach:

1. Understanding the Current System: Our consultants began with a thorough analysis of the existing manual eligibility verification process to identify bottlenecks and potential areas of automation.
2. Smart Bot Development: We developed an intelligent bot capable of logging into specific insurance sites and Availity. The bot was designed to mimic human-like interactions, seamlessly navigating through portals to verify patient eligibility.
3. Fetch & Analyze Data: Post verification, the bot was designed to fetch copay and deductible details for every patient with a scheduled appointment. This data was then systematically analyzed to ensure accuracy and consistency.
4. Alert Mechanism: Our Smart Automation system was enhanced with an intuitive alert mechanism. Whenever the bot identified exceptions or discrepancies in the patient data, it sent immediate alerts to the staff.
5. Integration with Staff Workflow: To ensure that the automated process complemented the staff’s daily workflow, the alerts were integrated into the practice’s existing communication channels. This allowed for real-time updates and immediate action.

Results:

1. Efficiency Improved: The automation of the eligibility verification process drastically reduced manual efforts, saving the medical practice significant man-hours every week.
2. Enhanced Accuracy: The bot’s data-fetching capabilities ensured that errors related to copays and deductibles were minimized, leading to accurate billing and reduced revenue leakage.
3. Proactive Problem Solving: The alert mechanism empowered the staff to be proactive. They could immediately contact patients for correct data, ensuring a smooth patient experience and reducing last-minute cancellations.
4. Improved Patient Satisfaction: With accurate billing and a streamlined process, the practice witnessed an uptick in patient satisfaction levels, reducing disputes and improving trust

Conclusion:

Rekha Tech’s Smart Automation solution for eligibility verification transformed a traditionally tedious process into a seamless, efficient, and accurate system for the medical practice. The successful implementation underscored the potential of harnessing technology to drive operational efficiency in the healthcare sector.