Medical Claims Automation Manager

The challenge

COVID-19 has resulted in millions of Americans losing their jobs and healthcare benefits, prompting a surge in Medicaid claims as newly uninsured patients needed to be tested or hospitalized amid the Coronavirus pandemic. 

State and local agencies are overwhelmed, faced with antiquated systems, and ever-changing coding requirements. As a result, few claims are being processed quickly or efficiently.

The solution

In partnership with Blue Prism and Red Hat, we’ve created Medical Claims Automation Manager; a fully integrated, secure, and automated claims processing solution that helps patients and providers execute claims faster and more efficiently. The Medical Claims Automation Manager empowers a Blue Prism digital workforce to:

  • Flag improperly coded COVID-19 claims from providers
  • Verify ICD10 codes are correct and related to services performed
  • Verify patient enrollment status and benefits availability
  • Verify patient/provider enrollment completion in MMIS
  • Re-route incorrectly coded COVID-19 claims to the appropriate API
  • Scan forms and submit patient claims for reimbursement

Learn more

Find out how you can process thousands of claims in a matter of hours instead of weeks and give
much-needed assistance to patients and providers in times of crisis.