Automating Eligibility & Claims with RPA: 1,200+ Staff Hours Saved Annually.

About This Project

A multi-specialty group practice consisting of 22 physicians was spending about 25 hours each week on two non-clinical activities: patient eligibility checks and claims status follow-ups via seven different payer portals. These processes were carried out manually by the billing department daily, involving logging in, searching, documenting, and logging out of the portals. This was a mundane task that took significant time away from denial management and other crucial follow-ups, making it a perfect candidate for automation via Robotic Process Automation.

Challenges

Manual Work Involving Seven Payer Portals Over 25 Hours Per Week

The billing staff had to manually log into the seven payer portals several times each day to verify patient eligibility. Verifying a single claim usually took from four to eight minutes, resulting in more than half an FTE spent exclusively on one task.

Frequent Data Entry Mistakes

Verifications were done manually, which resulted in incorrect data entry. As a consequence, wrong eligibility determinations were being made. Claims were being filed for patients who had expired or changed their coverage, yet the error remained undetected until denied by the payer.

Absence of Consistent Workflow

The workflow of checking eligibility and claims status differed between every billing specialist. There was no standardized approach, no guaranteed time of completion, nor any means of identifying potential bottlenecks that would negatively affect revenue cycle management.

Claim Status Check Lagged and Reactions Were Reactive

Without a system to track claims status, pending claims could remain outstanding longer than necessary without any follow-up. There was no proactive monitoring — only reactive management of aged accounts receivable.

Solution

Custom RPA Bots Across All 7 Payer Portals

Bots were customized for each of the seven different payers’ portals by CureMed. These bots will login, gather information, and make updates to the practice management system without any manual intervention.

48-Hour Pre-Appointment Eligibility Checks

Verifications for each appointment are run 48 hours before every appointment via the bots, and if there is any problem regarding insurance coverage, they are directed to the desk personnel before the actual appointment — not when the claim gets denied.

Automated Claim Status Updates & Exception Routing

Bots check all outstanding claims on a pre-defined schedule, update the status within the practice management software, and determine if any claim requires human intervention. Exception-handling processes ensure that any exception is routed to the appropriate person, complete with context information.

How the Automation Works

1. Appointment Scheduled — Patient appointments enter the practice management system.
2. Bot Triggers at 48 hrs — RPA bot automatically initiates eligibility check on the relevant payer portal.
3. Result Recorded — Eligibility status is written back to the practice management system instantly.
4. Issues Flagged — Coverage gaps or mismatches routed to front desk for resolution before visiting.
5. Claim Filed Clean — Verified eligibility feeds directly into charge capture — no manual re-entry.

Key Deliverables

• Custom-built RPA bots for all seven payers’ portals — eligibility and claim status automated completely.
• 48-hour eligibility batch process executed daily with no human intervention required.
• Claim status checks automated according to scheduled timelines with automatic updating of results into the practice management system.
• Workflow to handle exceptions where the bot fails, or there are edge cases, directing those issues to the right person and providing complete information.
• Consistent eligibility and claim status process ensured through automation; no variations possible based on different staff members.
• More than 1,200 staff hours are saved annually.

Results

The billing team spent one-fourth of their week signing into portals. It was essential for the job, but it did not require skill. The bots from CureMed relieved them of that responsibility. After three months, our collections increased by 15%, not by hiring new people, but by giving our current staff time to do what makes a difference.

— Revenue Cycle Director, Multi-Specialty Group Practice

Why It Worked

These are two operations which would have been ideal for robotic processing technology. Both have high volumes, involve rule-based work, and are highly time-sensitive — everything that robotic process automation is great at. The only reason why they were still being conducted manually was the absence of an automated system for that purpose.

CureMed has provided this infrastructure. Bots were not there to replace the billing team; they were there to get rid of the aspect of the work that prevented the employees from getting their real work done. The growth in revenue by 15 percent has not been a consequence of robotic processing but of the billing department’s actions.

Multispecialty clinics are particularly vulnerable to eligibility and claims status inefficiencies. An increased number of clinicians, payers, and appointments makes manual inquiries more necessary — and increases the potential for mistakes and delays. RPA turns that volume from a liability into a non-issue. The bots scale. The errors don’t.