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Automating Claims Payment Clearing in Meditech

SphereGen Case Study

One of the many steps in claims processing is clearing the claim from the EHR system after it has been successfully paid. This is a tedious process involving file imports and payment matching.

Learn how SphereGen helped a Washington hospital implement automation to process claim payments and clear the claim, saving overall operations time and staff efforts.

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Automating
Claims
Payment Clearing in Meditech

SphereGen Case Study

One of the many steps in claims processing is clearing the claim from the EHR system after it has been successfully paid. This is a tedious process involving file imports and payment matching.

Learn how SphereGen helped a Washington hospital implement automation to process claim payments and clear the claim, saving overall operations time and staff efforts.

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O V E R V I E W

Claims processing is a multiple step process which involves several points where hospital staff is involved in data entry, review and error resolution. Having the opportunity to automate any of the steps in claims processing leads to overall process improvement by decreasing staff effort and time and increasing accuracy.

Our client, a community hospital, automated the step of claims payment processing from their Meditech system. Staff was relieved of the tedious tasks involved in clearing claims payments and gained back roughly 25 minutes from each day.

Challenges

For our client, the process of clearing claims for payments involved multiple steps of importing and exporting claims and payment files. If any of the claims information was missing or erroneous, staff had to correct the error(s) before the final steps of clearing could be completed.

This process was incredibly monotonous and depending on the number of claims to be processed, could take upwards of 20-30 minutes each day. In addition, accounting staff had to wait for the clearing process to be completed before they could continue with their payment workflow.

SOLUTION

SphereGen created an automation which logs into both the clearinghouse and Meditech systems and transfers the necessary information to process a payment and clear a claim. If any claims data is missing or erroneous, the automated bot can retrieve the correct data and insert it into the claim, so processing can continue. All steps of the process send notifications to the appropriate team, so they are aware of the process status at each step.

RESULTS

Due to the automation to clear claims, manual effort in the process is no longer required.

Time
Saved

0 min/day
Processing time reduced from 25 minutes/day to 0

Complete
Automation

0 %
No more manual work, process is completely automated

Removed Task
Dependencies

0 %
Automation enables tasks to be scheduled 5 hours earlier, removing task dependency

THE DETAILS

In handling claims clearing manually, our client was not only experiencing a time drain to complete the work – the availability of the workstation running the process was dedicated while the file transfers were running. In addition, Accounting was dependent on the clearing process to be complete before they could continue with some of their tasks.

Automating the process resolved these issues. The RCM staff gained roughly 25 minutes each day where they are free to work on other tasks. By running the automation early in the morning, Accounting’s work is no longer dependent on the RCM team to complete the clearing process.

APPROACH

In automating our client’s claims clearing process, the following steps were taken:

Auto Login to Claims Systems with File Transfer

When the process begins, an unattended automation bot logs into the clearing house system. The clearing house files are received and readied for processing. The bot then signs into Meditech and imports all clearinghouse files.

After the claims are cleared in Meditech, the bot checks to make sure that all records coming from the clearinghouse match the records that were processed in Meditech. If the result is correct, the bot will transfer all cleared claims back to the clearing house. If there are any errors in this process, the appropriate status emails are sent to notify staff that there was an error in the process.

Error Resolution

When cleared claims are transferred back to the clearinghouse, some claims information may be missing or erroneous. The bot will check for these errors and fix them accordingly so that processing can continue.

Status Notifications

Whenever there is an error in the process or when the process has been completed, emails are sent to the appropriate team members, so they are kept aware of the process status. These notifications are all handled from within the automation.

CONCLUSION

By automating the claims payment and clearing process, our client was able to realize benefits in the following areas:

  • Time Savings – the RCM team saves 25 minutes each day as claims no longer need to be cleared manually.
  • Reduced Task Dependency – the automation creates the opportunity to schedule and run the job early in the morning. This allows the Accounting staff more freedom in addressing their own tasks which were dependent on the completion of the claims clearing process.
  • Task Shifting – RCM team members now have more time in their day to focus on other tasks.

In realizing the benefits brought about by automating payment processing and claims clearing, our client is eager to automate more steps of the claims process. Automations in this area will greatly improve the RCM team’s overall productivity by reducing manual efforts and the errors associated with manual work.

SphereGen is a technology company that specializes in developing innovative solutions in healthcare to improve patient experiences and outcomes. Our customer-centric approach focuses on finding the right solution to meet the need at hand, using technologies like Intelligent Automation to improve workflow and productivity. In support of general Healthcare requirements, we also offer custom software services in Application Modernization/Support and Extended Reality.

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