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Robotic process automation can speed payer claims processing

Health insurance payers and healthcare providers can take advantage of robotic process automation to make claims processing more efficient by reducing the human component.

Rod Dunlap is director in the robotic process automation practice of Alsbridge Inc., a global IT infrastructure consulting and services company. In this SearchHealthIT "Ask the Expert" interview, Dunlap explains how RPA can help payers and providers that take on risk to further automate claims processing.

What is robotic process automation and how is it suited to claims processing for healthcare insurance companies, or payers?

Rod Dunlap: Robotics process automation is the next evolution in software development and lends itself very nicely to claims payment for health insurers. The first thing when you think about RPA is you are automating a manual process. So if you look at something like claims payments, you've got dozens, or in some cases even hundreds, of folks that are processing claims manually. They follow a standard operating procedure, and that SOP is really made up of a series of reads from their terminal, a series of decisions or business rules and then a series of actions that they take by entering information in through their keyboards. And that's all that a robot really is. It takes that same process and it simulates the eyes of a claims examiner, it simulates the brains or the decisions made by a claim examiner and then it simulates the activities taken on the keyboard. So it really is automating a manual process.

Rod Dunlap, director in the RPA practice of Alsbridge, Inc.Rod Dunlap

One of the other things that comes to mind that makes RPA different than traditional development is the fact that there are no system changes required. Normally, when you build automation, you think that I've got to build APIs or I've got to build services or some way to interface with the existing adjudication system or membership system or medical review system. With RPA, you're interfacing at the user level just as the human does. So you're not required to make any system changes at all. So those are two of the things that make RPA much different than traditional automation.

If two or three people are doing the same repetitive tasks, they are candidates to be replaced with RPA robots.
Rod Dunlap

Could healthcare providers that are taking on risk, whether as payers or accountable care organizations, possibly benefit from RPA as well as traditional insurance companies?

Dunlap: Absolutely, any time where there's a manual process. And normally, we kind of think if there's two or three people that are doing the same repetitive tasks, they are candidates to be replaced with RPA robots. So you know, there's a very high likelihood that they would benefit from RPA as well.

Are there any other possible uses for RPA in healthcare or health IT, such as scheduling, credentialing, revenue cycle management or health data management?

Dunlap: Yes, I've been working with probably a dozen health insurance companies, and ... they all have applications that lend themselves to RPA. Examples are in the membership area, in the back office, accounting and HR areas. So there are an awful lot of applications. But claims is where I see it most often and has [been] the first or easiest [area] to achieve payback, but it applies across the industry.

Next Steps

An overview of how IT firms expect to gain from RPA

IT services industry undergoing RPA transformation

How business practice management uses robotic process automation

This was last published in June 2016

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