Reduced revenue leakage
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.
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.
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.
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.