Cerner Encounter Payer Validation Case Study

Systems: Cerner

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Challenge:

A leading healthcare provider with over 50 hospitals needed to streamline its eligibility process utilizing Robotic Process Automation (RPA). CampTek Software, with its experience in Healthcare (RCM) and more importantly the Cerner PFS system, instituted its RPA full life cycle methodology to design the automation successfully within weeks with great success.

Full-time employees had to manually enter an encounter number, name and several other demographic information for over 670 patients daily. The workflow had many steps and variables that added to the overall complexity. The process it manages 4 payers: Aetna, Blue Cross, Humana, United Healthcare and includes business rules and exceptions for each.

Solution:

By utilizing Robotic Process Automation (RPA), CampTek Software was able to automate the entire process. The timeline from analysis, development, client acceptance and then into live production was a roughly four weeks from start to finish. The 13,000+ claim checks per month runs daily and has shown to dramatically reduce A/R days with very high success. FTE hours saved is averaging 542/month. The Bot types data into 30 fields and loops through images and handles unexpected errors in Citrix. With the success of this first RPA Bot in only one of its Central Business Organizations, the customer now plans to roll it out to an additional 21 CBO’s.

Facts about this Bot:

• Number of payers: 4 (Aetna, Blue Cross, Humana, United Healthcare)
• Exception handling: The bot handles 10 business rule exceptions, 4 manually thrown system exceptions and any other random system exceptions
• Transactions per month:  11000-14000
• Saves over 1000+ hours a month in manual hours

Healthcare, RCM, Insurance

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RCM teams