Automating the Accounts Receivable Update Process

Solution

Nalashaa’s RPA team worked on building a robot to do the same work as the customer support team. The team divided the process into 2 parts.

• Bot Assignment: Whenever there is an update in the Denied Claims list, the team just updates the below details.
  • ‘Action Code’ column for the Action that needs to be performed by the bot.
  • Assign the record to the Bot’s account.
• Bot in Action:
  • Bot reads the tracker daily.
  • Filters the records assigned to the Bot account.
  • Identifies the ‘Action Code’.
  • Performs the appropriate actions.

Functionality

The bot logs into the tracker and accesses the Denial Worklist containing the list of available batches and checks for action codes.

Identifying the transaction

It then accesses the GPMS application and identifies the respective transaction by its Date of Service and the Due Amount as mentioned in the tracker.

Executing the Action

Based on the code in the tracker, the bot processes one of the following 7 actions.

• MOVBAL (Move existing balance to patient balance): The Bot searches for adjustment entries and if found, moves the balance amount to the patient account.
• SWPINS (Swap insurance for Denial): Bot accesses the Insurance Tab and copies the primary insurance details to the secondary insurance section and vice-versa.
• ADDINS (Add New Insurance): The Bot adds insurance details such as INS codes, policy numbers, etc. to the Insurance Tab tracker that mentions the insurance type (Primary/Secondary).
• REMINS (Remove insurance and bill patient): If the insurance type in the Insurance Tab is Primary, the bot replaces the details with secondary insurance information. If the insurance type is secondary, the bot replaces it with tertiary insurance information.
• UPDCOB (COB set update): The Bot searches for the account in the COB set entry and updates the group code in the respective entry.
• UPDDIS (Diseased patient update): The Bot accesses the patient’s demographic details and updates the deceased date.
• CORCLM (Corrected claims): Bot reads the charge details and adds a charge message for corrected claims.
• Add Comments: Once the actions are performed, the comments provided in the tracker will be added to the transaction.

Handling Exceptions

The bot checks for process validations at every stage and sends alerts for any exceptions.

Benefits of implementing RPA

• Process automation – Allows the human workforce to focus on value-adding areas such as talking to patients and insurers which can’t be done by the Bot.
• Round-the-clock operations – Higher productivity and faster delivery
• Accurate handling of repetitive tasks – Fewer errors and enhanced customer satisfaction
• Low maintenance costs and no additional overheads – Improved bottom-line