Medical Claims Automation Manager

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.

MEDICAL CLAIMS AUTOMATION MANAGER

MCAM

THE CHALLENGE

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.

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.

MEDICAL CLAIMS AUTOMATION MANAGER (MCAM)

THE SOLUTION

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

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