Navigating the future: Automation and AI’s role in efficient healthcare claims processing

Addressing challenges with medical claims processing across both the payer and provider landscapes was a central focus at the recent UiPath AI Summit 2024, where industry experts discussed the potential of AI as a transformative force in healthcare. 

Why was claims processing the most talked about topic in this year’s healthcare breakout session? According to Deloitte, improving the revenue cycle, including lowering payment times and redesigning processes, was ranked the biggest driver to improve profitability by health system finance leaders. On the health insurer side, many insurance stakeholders find themselves unable to process claims promptly or accurately as caseloads continue to grow.

This often results in mistakes being made, claims being inappropriately denied, and a considerable amount of time being spent on rework. Ultimately, these inefficiencies and errors encroach on the bottom line, making it a concern not only for operations but right up to the C-suite level.

Industry experts discussing how automation and AI are transforming healthcare included: 

• Paul Torrey, Senior Industry Practice Director at UiPath

• Rajusiva Arunachalam, Vice President, Head of Automation and AI for Omega Healthcare

• Suresh Kumar, Chief Technology Officer at Expion Health 

Through their insights, it was clear that AI-powered automation, particularly intelligent document processing (IDP), could play a pivotal role in resolving these issues.

Omega Healthcare

Omega Healthcare’s model of transitioning towards automation, as shared by Arunachalam, provided an interesting case study. With its broad spectrum of hospitals and facilities, primarily in the United States (U.S.) and tied to the stringent security and compliance requirements, Omega Healthcare needed an efficient solution to handle complex, data-intensive processes.

They found success with UiPath Document Understanding which utilized AI and pre-trained models to handle unstructured data extraction.

Read the details about how they used Document Understanding and other tools available via the UiPath Business Automation Platform.

For their innovation with automation and AI, Omega Healthcare was named a 2023 UiPath AI10 award winner.

Omega’s shift towards AI-driven automation powered by UiPath has been instrumental in ushering in efficiency savings, cleaner claim ratios, and increased collections.”

Rajusiva Arunachalam, Vice President, Head of Automation and AI, Omega Healthcare

Arunachalam elaborated on Omega Healthcare’s future plans of implementing more AI solutions, perfecting conversational AI for after-call work automation, and extending automation processes to support functions like HR and admin. The bottom-line benefits derived, impressive increases in efficiency, and high data accuracy rates underline the potential AI and automation hold for the healthcare industry.

Expion Health

Discussing how Expion Health leveraged AI with automation to increase its claim processing capacity, Kumar shed light on the timeline of this remarkable shift.

The infusion of AI didn't just augment our capacity but also accelerated the pace of our processes. Within a surprisingly short span of merely three to four months post-deployment, our claim processing volumes experienced a significant boost. We saw our daily average rise from a humble 70 claims to an astounding 400-plus.

Suresh Kumar, Chief Technology Officer, Expion Health

IDP not only helped to streamline Expion's operations but also introduced a new level of precision. AI-powered automation of document processing effectively replaced cumbersome manual tasks, freeing up the workforce to focus more on the analytical and decision-making side of the operations. As a result, Expion Health experienced a significant enhancement in its overall efficiency and productivity. 

As the accuracy of claims processing improved by reducing the incidence of errors and reworks, it led to improved patient satisfaction and a healthier bottom line.

Hear how 2023 UiPath AI10 Award winner Expion Health used automation and AI to streamline their data entry process—a process that extended across six systems.

Their journey serves as a model to inspire other industry peers, to chart their technology-led transformative course.

Read the full Expion Health customer story.

AI and the future of healthcare

These journeys underscore the promise that AI and automation hold for the future of healthcare. By choosing to embrace these technologies, healthcare entities can improve efficiency, reduce manual errors, speed up processing times substantially, and significantly improve service delivery. As AI continues to evolve, we can anticipate a tremendous, exciting, and beneficial transformation in the healthcare sector.

Access more insights into AI's transformative impact on healthcare by watching the full recording of the UiPath AI Summit. Learn at your pace from various insightful sessions by industry experts.