R1 RCM efficiently automates over 32M tasks annually using RPA

THE WHOLE STORY

R1 started by automating their core business process: claims processing. It is important to note that while the company’s staff are still a very important part of this process, many of the steps requiring manual interventions are now automated. This is a great example of RPA enhancing staff productivity. The company deployed RPA to automate various steps. Prior to claim submission to an insurance company, validations or “edits” are applied to increase the likelihood of payment. Without automation, to resolve errors flagged by the validation process, information from various systems is typically gathered manually. This process of information gathering and resolving the “edit” is now automated through RPA saving significant staff time and effort. After the claim is successfully submitted to the insurance company, its status must be checked at regular intervals to determine if any intervention is needed to obtain payment. Some industry standards exist to perform this process; however, R1 realized the information obtained generally lacks the detail required to resolve the claim issues. Today, these status checks are automatically obtained through RPA and imported into R1’s proprietary workflow platform to ensure only claims requiring intervention are sent to staff to address.