Gentem Health:
How to automate medical billing by optimizing the process of syncing health data?
Location:
San Francisco, US
Technology:
UiPath
Client
Gentem Health is a Silicon Valley-based company that aims to help healthcare providers build thriving organizations by simplifying the reimbursement process and elevating the patient's financial experience.
Gentem accomplishes this by leveraging technology such as Artificial Intelligence, automation, and data to streamline and accelerate reimbursement.
The Challenge
Gentem provides the medical billing processing service on behalf of its clients. To process the billing claim, the company collects all the necessary information about the appointment, such as patient billing info or provider info. It passes the data to the appropriate medical insurance company manually.
Our goal was to organize the process of passing data in the fastest and safest way for all participants.
There were two main issues with the process:
Firstly, the process took a lot of time, engaged multiple people on the company’s side, and generated unnecessary costs.
Secondly, mistakes in pulling and passing the data occurred (since it was work done by an actual human). Problems like this can put Gentem in legal danger since the data in the medical industry is super sensitive. Plus, there's also the chance of jeopardizing the company's and insurance providers' relationship.
The Solution
Medical billing is a complicated and work-heavy process but is also very rule-based (in most cases) and repetitive, which are the perfect traits of a great automation candidate.
We had to focus on data from Electronic Health Records.
EHR is an application that allows storing all the data used in the health practice, like:
- Patient basic information (basic info, contacts, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information
- Healthcare providers' info (NPI, licenses)
- Schedule appointments. Most of them provide some solution for medical billing.
Our RPA developers have proposed a solution of an RPA-based integration between multiple EHRs and Gentem’s databases.
In the new process, we take the relevant data (patients, providers, service locations, appointments, service lines, payments) from the EHRs and insert it into Gentem’s database so they can process insurance claims based on the information provided.
The new system syncs the data from multiple practices using multiple EHRs daily.
The Outcome
The result of the whole process was a well-structured outcome. It gained new levels of speed and accuracy.
Thanks to our previous experience in working with medical records and EHRs, we were able to understand the industry-specific challenges of the Client, as well as the sensitivity of the data we were processing. This gave us a unique angle to solve Gentem’s problems.
As a result, productivity increased, and Gentem’s team could take care of more important tasks instead of manual data processing.
The company can now focus on working with patients and partners. Our UiPath developers and RPA consultants can do the rest!