Hyperautomation – Powering Healthcare Claims Submission

Healthcare claims submission can prove to be quite an arduous task for healthcare providers. Traditional claim submission can prove to be quite complex, and time-consuming, and often leads to claim denials. From poor management to complex medical coding and billing, there are several reasons why healthcare claim submission impacts the overall practice revenue.

The key steps of healthcare claims submission are data extraction, verification, and submission of the encounter data. Hyperautomation can play a major role in the claim submission process by involving programmed bots that can collect and verify data thereby ensuring claims submission is fast and accurate. Organizations using hyperautomation in claim submission can automate the entire process, to improve overall efficiency.

Based on a 2022 report, healthcare systems are implementing automation in their administrative functions to reduce operational costs and improve healthcare services. However, to achieve large-scale digital transformation, the healthcare sector needs to embark beyond automating individual and siloed processes using just Robotic Process Automation (RPA). Instead, they should attempt to execute end-to-end intelligent process automation employing a holistic strategy. This is where hyperautomation for healthcare claims submission comes into the picture.

Hyperautomation combines robotic process automation (RPA) with advanced technologies such as artificial intelligence (AI), machine learning (ML), process analytics, and many more to help businesses accomplish end-to-end process transformation, vital to their long-term objectives. This can be used to go through tons of information in the extraction stage, for verification checks, and all other stages in the full lifecycle of claims.

There are two main reasons why hyperautomation seems important in the healthcare industry right now. One of the reasons is patient comfort and treatment. After the pandemic, patient care has become important and around 90% of healthcare technology specialists want to focus on it. So, resources can be better allocated to focus on patient care. On top of that, around 80% of healthcare providers still use legacy systems that need modifications and improvements. Replacing this can disrupt business functions and create issues with integration. Hyperautomation enables businesses to integrate digital technologies across their processes and legacy systems.

The healthcare sector looking to merely automate any random claim submission process with Robotic Process Automation (RPA) will not find it to be a sustainable solution. Instead, they need to opt for hyperautomation, combined with Machine Learning (ML), RPA, and Artificial Intelligence (AI), to achieve elevated levels of intelligence and process efficiency. Since healthcare providers submit large amounts of claims, there are bound to be human errors in such claims. Hence, claims submission automation can help to speed up this process and also lower errors during claim submission.

Some of the key dimensions that can be innovated and revolutionized with hyperautomation include:

• Higher Predictability: Having an automated bot in place that makes use of an AI rule engine and algorithms, healthcare providers can effortlessly evaluate and predict healthcare claim denials. They can use retrospective data to track which claims were rejected or returned and based on that information, ensure better accuracy. Unlike humans, hyperautomation can work round the clock and ensure the accuracy of the claims.
• Mitigating Human Errors: One of the problems with healthcare claims is the high volume. When human workers are preparing health claims, there is a high chance of human errors that can take place. This can constitute wrong data or even improper medical codes. Improper use of modifiers can also result in claims denial. Since validating data and attention to data are integrated within the automatic process, healthcare claims remain mostly accurate.
• Scaling Up: Another way in which hyperautomation can help is by scaling up healthcare claims submission. Human workers have a limited capacity to work and hence, scaling up can be a limiting factor for human workers. However, with hyperautomation, it is possible to scale up at an immense level. Firstly, hyperautomation ensures that accurate data is submitted and once the bot is trained, it does not need a re-training process. That way, key human workers can focus on other areas of the healthcare sector.
• Improved and Efficient Returns: On the whole, hyperautomation can help in bringing efficient returns to healthcare providers. Accurate and faster claim submissions means that there would be less time spent in back-and-forth interactions over erroneous claims. Since bots learn, it would also mean that the healthcare sector does not have to spend time retraining individuals or onboarding. A trained bot can last for a long and hence, it can bring higher returns. Hence, while hyperautomation can be costly to implement in the first stages, it can bring better returns in the future.

Healthcare organizations across the globe saw a massive surge in healthcare claims during the pandemic. On top of that, medical spending, which increased during the pandemic, is bound to reach pre-pandemic levels. So, this implies that now, healthcare providers should find a way to lower their operational and administrative costs. One of the ways is by using technology to lower administrative costs. As per Gartner, it is already projected that by 2024, organizations will lower their operational costs by 30% by using hyperautomation.

Hyperautomation is one of the top technology trends of 2022, and health insurance claims are a prime area to benefit from it. If automation revolutionized the healthcare sector, then hyperautomation is the next logical step to make it more efficient and sustainable. It also equips the healthcare sector for the new era of automated, accurate, and more efficient processes. The consequent modification in products and services will lower operational costs, mitigate human-related errors, and improve efficiency through better management of resources. As such, the healthcare industry would be successful in lowering its operational cost and focusing on better health outcomes.