AI Challenge - EPIC Intelligent Claims Extraction and Reconciliation - CMS-1500 and CMS-1450

AI Challenge - EPIC Intelligent Claims Extraction and Reconciliation - CMS-1500 and CMS-1450

Use Case Description

Healthcare Claims extraction and reconciliation processes involve manually keying claims data using unstructured documents, where EDI was not available. A top healthcare cost-management and revenue optimization provider company wanted to avoid manual data entry processes to reduce the time it takes us to provide pricing on the claim and also to be able to process more claims per day than we are able to with current manual steps.
Manual Processing

75 claims per day per resource
Peak day minimum 600 to 700, resulting to backlogs

The solution is to integrate UiPath with claims data extraction from EPIC and performing Document Understanding on downloaded claims documents leveraging AI to accelerate processing from 75 claims/day/resource to 500 claims/day/resource, and to improve the turnaround time by 100%. By leveraging DU, AI Center, Action Center, and other more advanced components in UiPath such as computer vision (to interact with Citrix applications), there’s been tremendous amount of effort saved in building the necessary features from scratch to help enable intelligent document extraction and seamless human-robot collaboration.


Use Case Artifacts (Process Flows, Insights KPIs, etc).zip

Other information about the use case

Industry categories for this use case: Healthcare Pharma, Information Technology and Services

Skill level required: Advanced

UiPath Products that were used: UiPath Studio, UiPath Action Center, UiPath AI Center, UiPath Document Understanding, UiPath Insights, UiPath Orchestrator, UiPath AI Computer Vision

Other applications that were used: EPIC EMR

Other resources: -

What is the top ROI driver for this use case?: Accelerate growth and operational efficiency


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