BOT for Authorization & Referral

Introduction:

Within a bustling medical practice, managing patient authorizations and referrals can become a time-consuming challenge, often leading to inefficiencies that can affect both patient care and operational effectiveness.

Challenge:
The medical practice confronted several issues:

1. Manual Processes: Office staff spent hours daily checking if each patient required an authorization or referral, leading to potential human errors and overlooked requirements.
2. Delayed Treatments: Due to inefficiencies, treatments often got delayed as authorizations and referrals weren’t processed in time.
3. Operational Costs: The practice realized that significant man-hours were being dedicated to tasks that could potentially be automated.
4. Potential Revenue Loss: Incorrect or delayed authorizations and referrals sometimes led to denied claims.

Solution Implemented by Rekha Tech:
Understanding the specific needs and challenges of the practice, Rekha Tech developed a specialized BOT to automate the authorization and referral checking process.

1. Identification & Initiation: The BOT was designed to automatically identify patients requiring authorization or referral from the practice’s database.
2. Automated Requests: Once a need was identified, the BOT initiated the request process well in advance, ensuring no delays in patient treatments.
3. Exception Handling: The BOT flagged exceptions or any inconsistencies in patient data, notifying the staff. This allowed staff members to focus only on specific cases rather than sifting through the entire database.
4. Continuous Learning: The BOT was built with the capability to learn from exceptions and continuously update its processes for better efficiency

 

Results:

35% Boost in Efficiency: With the BOT handling the majority of tasks, a single resource’s productivity surged by 35%.
Reduced Human Errors: The practice saw a significant reduction in overlooked or incorrect authorizations and referrals.
Timely Treatments: Delays in treatments due to authorization and referral issues dropped sharply.
Optimized Revenue Streams: With timely and accurate authorization and referral management, the practice observed fewer claim denials, leading to better revenue management.

Conclusion:

Rekha Tech’s automation solution revolutionized the way the medical practice managed its patient authorizations and referrals. Not only did it free up valuable human resources to focus on patient care, but it also brought in operational efficiency, reduced errors, and optimized revenue streams. It’s a testament to the power of smart automation in healthcare.