Project Description

Accounts Receivable

Industry – Healthcare

500k+

Daily claims

$109K

Reoccurring Write Off

Healius Pathology manually processes hundreds of millions of claims annually. These claims cover multiple clinical systems aligned to Business Units with dozens of provider systems/portals. The claims have different processing per Account type (Commercial, Bulk, Private, Health-fund).

Solution

  • Ingestion 0.5M of claims daily for processing

  • UiPath workflow implementation to validate claims and gather missing information using Human in the loop mechanism

  • Data preparation for submitting claims on Heath fund portals

  • UiPath process to submit claims on portal

  • Implementation of Rejection Triage using workflow management to define the correct allocation for reprocessing of claims

  • Claim tracking by processing statuses

  • Live Bi Dashboarding to provide insights on Revenue Leakage, Top Performing Health funds, Claim Tracking

Benefits

  • The solution eliminated work to submit claims on Portals.

  • Significant workforce reduction by automating rejection processing

  • Visual Dashboards helped in achieving process efficiency and highlighting key aspects to higher management for decision making to minimise the financial risk and loss

  • Accurate Claim processing by reduced the data quality issues which significantly improved the rejection rate

Results

  • Accurate and Fast Claim Processing —100% of NIB/Allianz claims are successfully submitted by the robot which drastically increased the timely payment originally from monthly to weekly

  • Process Improvement— Dashboarding to improve the bad debt provision of $1.1M and process improvement to overcome the gaps in system

  • Value Saved: $109K in write off – recurring

taxation planning

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