AgentHack submission type
Enterprise Agents
Name
Narendiran Thangadurai
Team name
FinCare
Team members
How many agents do you use
Multiple agents
Industry category in which use case would best fit in (Select up to 2 industries)
Healthcare Pharma
Complexity level
Advanced
Summary (abstract)
Elevating Healthcare RCM with Agents by writing medical codes and charge entry for each codes and claim generation.
Detailed problem statement
Medical billing is a critical part of the Revenue cycle management process (RCM) in healthcare industry in USA, The Biller ensures the Provider is reimbursed for their services (by the Payer and Patient). Healthcare providers must manage collections from multiple sources like Medicare, Medicaid, and Private insurers. This complexity reiterates the need for effective RCM systems to handle revenue streams.
The Challenges currently faced by the industry are,
Global shortage of medical coders leaving healthcare organizations struggling to meet their coding needs
Biller must ensure the Claim is compliant, with right diagnosis codes matching Procedure codes
Bill needs to be formatted as per the requirements defined by the Insurance company
Generate bills as per the insurance agreement (between Payer and Patient)
Global shortage of medical coders leaving healthcare organizations struggling to meet their coding needs
Detailed solution
AI powered solution built on UiPath Maestro, Agent builder and other UiPath products like Low-code Apps, Action center, API workflows and Robotic workflows.
UiPath AI Agents will be used for the following 2 critical processes in RCM,
-Medical coding Agent - Conversion of medical records from the clinician texts, into structured codes based on a classification system for the appropriate patient diagnosis and relevant procedure
-Medical claim and billing Agent - Collect the information from the Coder/ Provider through Superbill, generates the claim and sends to the Insurance company
Each of this Agent will be calling Robotic and API workflows for performing actions on core applications in the Healthcare Insurance industry, Human-in-loop workflows are triggered through Action Apps for final verifications by the SME. As part of the solution the context grounding indexes will be defined for referring to the knowledge of artifacts like regulatory, compliance and policy guidelines.
Demo Video
Expected impact of this automation
- Optimize Revenue Cycle Management in healthcare
- Less rejection in claims
- Less/No errors in medical claims form and medical bill
- Enhance operational efficiency, reduce costs and improve service delivery
UiPath products used (select up to 4 items)
UiPath Agent Builder
Integration with external technologies
N/A
