How RPA Optimizes the Medicaid Claims Submission Process

Processing Medicaid claims submissions can be time-consuming and inefficient, and it leaves a lot of room for human error. For organizations that process hundreds to thousands of claims each month, manually processing Medicaid claims is a drain on valuable resources. Some organizations have several employees processing claims for multiple states nearly all day, every day.

In the healthcare industry, it’s imperative to be efficient with employee time and allocate resources where they can make the most significant impact. This is even more important when qualified employees are difficult to find and retain.

Robotic Process Automation (RPA) can significantly reduce the strain of Medicaid claim submissions. This software intelligently automates the process, improving efficiency, accuracy, and speed. It also eliminates the need for your talent to perform rote, mundane tasks and allows them to focus on adding maximum value to your organization.

Using Robotic Process Automation to Submit Medicaid Claims

RPA performs the steps of submitting Medicaid claims without human intervention. It essentially emulates an employee who would otherwise be sitting at the computer, moving the mouse, clicking buttons, and typing on the keyboard. It automates manual workflows, eliminating high-volume, repetitive tasks that inhibit productivity at your organization.

The software is often customized to fit your organization’s business processes and needs or the demands of the system accepting submissions. Once implemented, the tool captures and enters data from the Medicaid claim and scrapes data from images and PDFs automatically, faster, and with a lower likelihood of error. If there are issues with an individual submission, the technology will notify you so you can manually address the problems.

RPA eliminates slower, error-prone, labor-intensive processes and has the potential to save your organization time, reduce risk, and expedite revenue. It improves data integrity, and it introduces opportunities to increase productivity.

• Time savings – Your organization is likely to realize appreciable time savings corresponding to the number of claims you submit and how long the process usually takes.
• Resource optimization – With RPA handling claim submissions, you can reallocate resources to other activities.
• Error reduction – The software automates this process with incredible accuracy, eliminating the concern of human error.
• Denials management – With a timely, automated entry process, your organization can more readily manage and remediate any denials to improve your overall revenue cycle management.

Importantly, these benefits are immediate with RPA. Your organization can realize returns very quickly, even as you continue to customize your solution post-implementation.

Understanding Robotic Process Automation as a Tool

RPA is a tool specifically designed to enable process improvements, such as automating manual Medicaid claim submissions. These are process improvements that other solutions, such as a new ERP, don’t typically enable on their own. Unfortunately, RPA isn’t always included in the conversation when organizations upgrade their technology. Its capabilities aren’t clearly understood, and it is often either neglected or used incorrectly.

Given the benefits of using this tool for this specific process, once it’s understood, it’s a no-brainer for most organizations today. This is true even if you can only automate a select set of your claims.

If you have 20,000 invoices each month and can automate submission for half of them, you gain reliable, consistent, efficient submission of 10,000 invoices monthly.

You reduce time spent and can reallocate employees to valuable tasks, such as bad claims and collections, or ease an already-heavy workload to help them get ahead on claim submissions.

Factors that Make RPA More Critical Today

Automation and process improvement have always been opportunity areas. However, several factors are making it both more accessible and more necessary in processes across industries.

RPA at Work in Healthcare: An Example

One managed care provider implemented a custom-built RPA solution from Eide Bailly to solve for the fact that they couldn’t upload their submissions in bulk. Previously, it would take days for their team to submit Medicaid claims one by one through state-run portals. The RPA solution automatically submits claims to the correct state Medicaid portal, then sends an email with the details of the submission to the team, including acceptance confirmation, rejection, and any errors that must be reviewed.

As a result, the billing team has saved time, there’s reduced risk of human error, they’re more efficient, and they’ve expedited their revenue stream as they don’t have to wait days to submit the claims – so they see reimbursements sooner.

RPA Solutions from Eide Bailly

Eide Bailly’s RPA services provide a tailored solution to simplify the user experience, automate manual workflows, and customize your business solutions to fit your needs. The customized RPA submits each claim to its respective state Medicaid portal without human intervention.

The Eide Bailly business process automation and optimization team has already built several out-of-the-box offerings for specific states, which can be tailored to your organization. The team can work with you to develop RPA for other states per your business processes and the state systems. In a matter of weeks to months per state, you can automate these processes and start realizing immediate benefits.