With over 300+ payers and a broad array of deployable service lines and patient types, we provide a full cycle automation solution for prior authorization: from pre-scheduled prior auth submission, status checking and denial prevention worklist alerts, as well as medical necessity verification and notification of admission.

Pre-service financial clearance teams, auth cert teams, any prior authorization staff doing medical necessity as well as authorization for services at acute care facilities or OP areas.

Industries: Healthcare, RCM

Provider Systems: Epic

Payer Portals: eviCore, United Healthcare, Magellan

Challenge

A large healthcare provider needed to ramp up their automation strategy to offset labor instability and attrition. Currently the staff manually have to go out to payer portals, submit requests and check statuses of Prior Authorizations, sometimes multiple times. Through Task Mining AI (Artificial Intelligence) analysis, it was determined that staff were spending about 30 – 40% of their time submitting requests and checking the status for 19,000 prior authorizations per month.

Prior Authorization Requests: 3 bots processing prior authorization requests in 3 separate portals (EviCore, Magellan and UHC).

• EviCore: 923 transactions per month
• Magellan: 595 transactions per month
• UHC: 7,063 transactions per month

Prior Authorization Statusing: 3 bots processing prior authorization statuses in 3 separate portals (EviCore, Magellan and UHC).

• EviCore: 5,536 transactions per month
• Magellan: 3,572 transactions per month
• UHC: 986 transactions per month

Solution:

RPA bots are a much more accurate and effective solution to verify the status of patient health authorizations, RPA bots can repeatedly check requests under review for status changes and updates.

CampTek Software was engaged because of its healthcare and Epic experience. Through task mining, AI models were created, and results were reported back to the customer with enormous success. The next phase of design and build all occurred in a brief time. The bot now in production includes business rules, exception handling and daily reporting functionality. It is also supported by CampTek as an ongoing managed service solution for the provider.

The Bot is now saving 2,696 FTE (full-time employees) hours per month or 32,352 hours (about 3 and a half years) per year. The FTE capacity gain is 17 FTEs (full-time employees), and the ROI (Return on Investment) is $1,085,000 per year.

Any healthcare provider