Home Case Study: RPA for Dental Claims Processing

Case Study: RPA for Dental Claims Processing

by Ant Sh
162 views
Case Study: RPA for Dental Claims Processing

Lateetud, a global boutique process automation company, shared a story of how it had helped its client to streamline dental claims processing.

Challenge

The customer processes large volumes of dental claims annually, and a big percentage of these have mismatched or wrong healthcare provider information. Some scenarios include:

  • Multiple providers on a single claim
  • NPI and Tax ID do not match existing records
  • Submitted NPI not found

Claims associates review each claim and assign the statuses approved to pay, rejected or override. Lateetud conducted process analysis to estimate that about 5,544 claims were processed monthly, and the current manual process successfully processed 40% of the current provider information.

Solution

Lateetud developed a Healthcare provider process automation solution, powered by Robotic Process Automation with an improved address matching logic. The team further simplified the process in the following aspects:

  • Single process to replace existing multiple parallel processes
  • More robust solution to avoid data load issues
  • Enhanced performance and efficiency

Benefits:

  • Eliminated manual review and research of claims information.
  • Simplified process with increased efficiency for associates.
  • Automated system to avoid human error.
  • Saved time for users to do more meaningful work.
  • Delivered ability to leverage address matching logic for future use.
  • Created analytics based capability to recognize new scenarios for automation.

Business Impact

  • Over 6,930 hours saved per year
  • 74% process improvement from existing 40%
  • 3,5 FTEs of lift delivered
  • Easy integration with existing systems and API for future customization

The Source