Healthcare Tech Company:
How to automate and scale the prior authorization process for a healthcare platform and save 13 FTEs?
Location:
United States
Technology:
UiPath, AWS
15K
items processed/month
~$700K
saved/year
About the Client:
The Client is a healthcare tech company from the US that offers a digital platform designed to optimize the coordination of healthcare services. Their goal is to bring true transparency to healthcare while enhancing efficiency, reducing administrative burdens, and improving patient care through innovative technological solutions.
The Challenge:
The Client solution facilitates communication between healthcare providers, patients, and their families, improving the quality of care and patient satisfaction.
They work with various insurers, each relying on a different platform or software. Because of the Client’s scale, manually executing the process was out of the question.
The goal was to fully automate the crucial part of their Revenue Cycle Management - prior authorization process with various insurance providers. The process has different instances, depending on the providers’ systems and the company’s home state.
We met with the Company’s executives during the HLTH 2023 conference in Las Vegas. After a short talk with their CEO and CTO, they decided they wanted to engage us on the project.
Solution:
Automation efforts were focused on a patient’s insurance verification workflows, which required connecting with various insurers’ middleware systems, Electronic Health Records, and NPI Registry.
Each automated workflow contains two main steps: