ActiveOps - Healthcare - Claims Audit

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Summary

ActiveOps has developed a 'prototype or demo' of an end to end healthcare services utilizing UiPath RPA. The workflow is around post payment Claims Audit.

Overview

The Claims Audit workflow is designed to work an assigned list of claims.  The objective is to compare the payment made for the claim with the appropriate state medicare negotiated price for the procedure code.  In the video, you will see the robot navigate the ActiveOps Claims system to identify key indicators such as location (State), procedure code, and the price paid.  The robot then will proceed to look up this code by state. If there is not a recent price table, the robot will navigate to the appropriate State Medicare site and download the revised spreadsheet of codes and pricing.  Once downloaded the robot will proceed to compare the price paid, relative to the state negotiated pricing.  If they match the audit passes if they do not match the audit fails and is noted accordingly for re-work.

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Published: 04 Jun 2020 | Updated: 18 Sep 2020