CoBot

Pre authorization Automation

Using RPA to automate the pre authorization process for scheduled services

Bot Profile

Efficiency

Complexity

Robotic Process Automation

Technology

Outcomes

Revenue

Productivity

Cost to Close

Benefits

Improved productivity
Reduced revenue leakage

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    Problem Statement

    The operations team needs to manually determine if payor preauth is required and then check/submit status of pre-auths. This manual process is inefficient and prone to misses in seeking pre-auths leading negative revenue impact.

    Solution

    Our team eliminated the need for human intervention by designing payor rules based on procedure codes, that determine the need for pre-auth. The CoBot uses the procedure code and reference number to submit pre-auth request to the payor website and check status for any prior requests submitted.

    Tech Specs

    Pre-authorization CoBot is an assisted bot that checks status and submits pre-auth requests to payor websites based on payor rules, driven by procedure codes.

    Expertise

    The system receives feed from HIS system for scheduled services.

    The procedure code (s) is (are) retrieved manually from HIS system. Rule-based checks are performed to determine if pre-authorization is needed as per payor rules. CoBot submits a pre-auth request with the specific payor website and can check the status of pre-auth request submitted earlier.