How healthcare agencies can tackle fraud, waste, and abuse with RPA

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How healthcare agencies can tackle fraud, waste, and abuse with RPA

State and local agencies are still feeling the strain of the COVID-19 pandemic on government health services — particularly as it pertains to processing claims.

Though the Coronavirus Aid, Relief, and Economic Security Act — or CARES Act — established a reserve for state, local and tribal governments to pay for testing and treatment of uninsured citizens, it also created payment channels different from normal daily claims. Errors with new coding requirements resulted in a mountain of backlog claims.

That’s why many state health agencies turned their attention to robotic process automation (RPA) tools to help with the growing pile of documents.

RPA automatically flags improperly coded claims, verifies enrollment status and benefits, scans forms and submits claims to proper payment channels, according to a new report, produced by FedScoop and underwritten by Blue Prism, Bits In Glass, and Red Hat.

Through rapid automation of manual rules-based, back-office administrative processes, RPA unburdens overwhelmed administrative staff in an already strained system. The new report dives deeper into the benefits of RPA technology.

Unprecedented demands during the crisis
When the pandemic hit last year, millions of Americans lost their jobs, prompting citizens to reach out for government assistance. That spike in Medicaid and Medicare claims caused a disruption in claims processing, especially for those states which still depend on legacy IT solutions and manual processes, according to Anna Twomey, senior solutions advisor and healthcare solutions architect for Blue Prism, in the report

She explained that with these delays, to the outside world, it looked like the money was not there, even though Congress had appropriated funds through the CARE Act to help.

Because the management of claims still uses manual processes, that creates a lot of backlog during spikes in demand, explained Josh Painter, RPA consultant with Bits In Glass, Blue Prism’s integration partner.

“These backlogs can be cleared when Blue Prism’s automation platform takes action on a document, and moves it into a system for verification, processing or reimbursement submission. It’s a simple way to make a big impact on the business,” he said in the report.

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