Client Challenge:

The client started their solution journey with the IBMi (AS400) machine to support their Billing/RCM (Revenue Cycle Management) product. Since their customers were on AS400, the involvement of manual support in the RCM services was high. Other solutions within their suite, such as EHR, Patient Portal, and PMS, were developed later with newer technology (Java)

  • The lack of access to skilled RPG programmers to maintain and upgrade the RCM product posed an ongoing business risk.
  • Newer programmers were unable to comprehend the current system functionality since there was no documentation of the existing solution.

With users demanding additional features (such as analytical capabilities, intelligent suggestions, scrubbing, etc.), and the CMS (The Centers for Medicare & Medicaid Services) pushing billing solutions towards newer regulatory changes, the client was on the verge of losing their market share to competition.

Solution

Nalashaa’s extensive Healthcare & AS400 experience arrived at the right time for help. The team engaged a functional and technical expert for a month to understand the current system setup. During the initial phase, the team analyzed the entire AS400 system and started documenting it at the functional, technical, process, and code level.

With knowledge gathered by the technical team during the first month, we engaged a team of RPG programmers to support the system independently. While the technical documentation and AS400 support were underway, our functional expert chalked out a product roadmap in-line with the regulatory requirements from the CMS.

We then onboarded another team that focused on new feature development and demoed the compliant product to the client in a short span of 6 months. We also setup AS400 support processes/KPIs to better manage the machine and for the customer to have improved visibility into the teams supporting the systems.

Further, enhancements through automation were carried out for some of the processes as requested by the client to eliminate human intervention.

  • Patient eligibility verification - The automation robot handles appointment details, generates eligibility check reports, and updates the front-office web portal.
  • Insurance claims status check: The bot reads claim reports in the system, logs into the corresponding carrier portal to identify the claim, and emails the details to the team.
  • Payment posting: The bot identifies the ‘Unposted’ claims in the application, creates payment batches, and performs batch reconciliation.

Benefits

  • Access to seasoned RPA professionals for high-level support and training of in-house teams
  • System documentation helps upcoming support teams to better comprehend the system functionality, and thus offer better services.
  • Automation boost to the resource-hungry and manually-driven processes.

Technology Stack

  • RPGLE
  • RPG 400
  • DB2
  • Java
  • UiPath

How to start the journey?

To choose the right AS400 support for your business, we would like to understand your needs better. The form below is a great way to start that!