The modern healthcare business environment is quick-paced and efficiency and precision are essential. Expion Health, a cost-management solution leader, realized this issue and made a great move to change its work with claims processing. Expion Health has reached new production and efficiency peaks by collaborating with qBotica, who is the pioneer of intelligent automation solutions, to increase the volume of claims processing by a record 600 percent.

This blog discusses the experience of Expion Health, the problems that were encountered, and how the AI-based solutions of qBotica transformed their business process of claims.

The Healthcare Claims Challenge

The Healthcare industry is ranked among the most dynamic and complicated sectors in the world with astonishing values of 5.1 trillion in the United States alone. It is a vital constituent of the economy and the absence of efficiency in the processes, absence of transparency, and the diversity of service prices represent great impediment to cost control. As an illustration, one MRI scan may cost as much as $375 in one health centre, and up to 5,000 in another. This non-standardization is confusing and increases the expenses to both consumers and insurers.

Expion Health is committed to this issue by assisting its clients, who may include large insurance institutions and self-insured employers, to find affordable prices using its cost-management plans. Their claims processing operations however suffered significant setbacks. In the past, the company had to use manual workflow systems with the significant burden of having to enter claims data in unstructured documents. The employees had to manually type in the data and compare it with historical and market data and give a recommended price.

This did not only use up a lot of time but also reduced scalability. Having a daily capacity of 75 claims, Expion was limited by its conventional processes particularly as the number of clients increased. Moreover, manual data entry was so high that there were high chances of errors in reducing efficiency and accuracy.

In that regard, automation was not a luxury, but a necessity. The size of the healthcare industry required solutions that would be able to match the changing needs and improve accuracy and relieve the employees of redundant time-consuming tasks. Expion Health realized this opportunity and made a strategic jump by collaborating with qBotica, an expert in intelligent automation.

To have a more in-depth discussion of healthcare automation, go to the Intelligent Automation page of qBotica here.

Why Expion Chose qBotica

The automation process at Expion Health had a very precise start, as the company had a clear goal to increase its claims processing capabilities without compromising quality and transparency. The organization has been able to select qBotica as a reliable UiPath partner that has been able to deploy high-quality automation solutions to various industries such as healthcare.

qBotica’s Expertise

qBotica arrived with a rich experience, and it used all the powerful instruments of UiPath, including Document Understanding, AI Center, and Action Center. These technologies also allow organizations to handle unstructured documents with unmatched precision with a seamless involvement of human intervention when needed. Incorporating a form of intelligent automation with predictive intelligence, the solution that Expion proposed provided qBotica with the means to make it not only efficient but also capable of meeting the long-term objectives of the company.

Strategic Collaboration

The case of Expion Health and qBotica did not involve the installation of out-of-the-box solutions. Instead, qBotica collaborated with the team of Expion to get acquainted with their pain points, draw up workflows, and develop an individualized automation plan. This strategy made sure that the solution concerned immediate and future scalability.

In the case of automation, the ability of qBotica to customize solutions is a game changer especially in the organizations wishing to automate. See how they can make your business better here.

The Transformation Process

Expion Health transformation had a four step process based on the end to end optimization of claims. The following is a closer look at each of the phases:

Automated Claim Downloads

The UiPath robots were implemented to download claims in PDF file format in payer systems and automate the process. This has saved time and energy that would have been spent in collecting data manually.

Data Extraction and Data Checking

Unstructured claims documents were through Document Understanding using UiPath to derive important data points. This AI based tool was able to classify and validate claims besides ensuring very high accuracy even in complex formats.

Human-Robot Collaboration

In cases where there were problems with claims extraction, the employees of Expion also relied on the Action Center provided by UiPath to identify and fix the mistakes. This human-in-the-loop system ensured quality management to make sure that no claim was handled wrongly.

Last Processing and Reconciling

The data was verified and then forwarded to the ExpionIQtm platform which processed the data and matched it against other available data to come up with fair pricing.

This smart automation and human intelligence has helped Expion to shift its workflow which was need-driven to a lean and highly efficient one.

The re-invention of Claims Processing at Expion Health by qBotica

Expion Health started its transformation with a strategic alliance with qBotica, the UiPath automation solution leader. They worked out a detailed strategy to automate the claims processing by means of high-end technologies and automatize the process of data extraction, validation, and reconciliation.

The Four-Step Process:

Automated Claim Downloads

The robot system was used to automate the claim collection process of payer systems without having to manually download it, which was eliminated by UiPath.

AI-Powered Data Extraction

Expion used UiPath Document Understanding to extract critical data points on unstructured claims documents. This guaranteed precision and saved a lot of time going through the process.

Human-Robot Collaboration

The Action Center at UiPath helped the employees of Expion to check and fix data when needed to ensure the quality control and to reap the automation benefits to their maximum.

Final Reconciliation

The purged data was inputted into ExpionIQtm, which is the proprietary platform of Expion, where it received pricing and reconciliation.

Such a smart combination of automation and the human touch allowed Expion to process up to 710 claims daily, which is a sharp contrast to the former ability of 75 claims.

Learn more about qBotica custom solutions.

Results That Speak for Themselves

The role played by the automation solution of qBotica in the functioning of Expion Health has been revolutionary. The following are some of the major outcomes:

• Claims Processed 600% Increase. Expion was only able to manage 75 claims per day before the automation. Since the implementation of qBotica solution, the company regularly obtained 148 claims daily on average, with the highest days of 710 claims. The impressive development highlights how intelligent automation can be scaled.
• Enhanced Productivity The 97 percent growth in total productivity has liberated employees so that they can concentrate on strategic projects and not on data entry processes. This has not only increased job satisfaction but also enabled Expion to provide improved and quicker results to its clients.
• Unprecedented Accuracy The solution would have a success rate of 99 percent in claims processing, which would limit errors, increasing client confidence and satisfaction.
• Faster Speed to MarketExpion has increased its capacity to respond to the needs of its clients in a competitive market by promoting the time taken to process and price claims severally through massive reduction.

These findings demonstrate the potential of the automation knowledge of qBotica to produce significant and quantifiable results. To have additional success stories, go to Case Studies of qBotica here.

Episodes of the Experience of Expion

The case of the automation project by Expion Health can offer some helpful lessons to other organizations that want to optimize their work processes:

The Vice of Collaborating with Experts

Selection of a partner such as qBotica, who has extensive knowledge in the ecosystem of UiPath, will make the implementation easy and achieve maximum outcomes. Their personalized strategy enabled Expion to resolve certain issues without necessarily re-engineering current systems.

Finding a balance between Automation and Human Supervision

Although automation can be used to perform repetitive activities accurately, quality control and dealing with anomalies cannot be managed by machines. The Action Center of UiPath enabled the smooth cooperation of AI and human teams.

Scalability and Changeability

The automation system planned by qBotica is not only effective, but it is also scalable, so Expion will be able to meet all of the future requirements and experiment with new automation systems.

Demonstrating ROI

The cost and benefits of automation projects are usually subject to doubt. The outcomes of Expion, which increased claims capacity by 600 percent and productivity by 97 percent, prove that intelligent automation will not be ineffective in terms of ROI.

To learn more, go to the Success Stories of qBotica here.

How Automation has affected the operations of Expion

The outcome of this automation program can best be described as being transformative. Expion was able to attain:

• 600% Increase in Claims Processed
• Enhanced Productivity
• Improved Accuracy

The capacity of the claims processing increased to 75 claims per day with an average of 148 claims being processed and 710 claims being the highest daily performance.

The productivity increased by 97 percent with automation and this left employees with strategic and value-added activities.

The success rate of claims was increased to 99 percent, which minimized mistakes and increased customer satisfaction and efficiency in operations.

Implications on Healthcare more generally

These innovations established a precedent in the healthcare sector, which smart automation can potentially change. Organizations such as Expion and qBotica are also clearing the path to a more transparent and affordable healthcare system through the management of inefficiencies in claims management.

• Future Automation in the Healthcare Industry
  • Enhanced Proactive Analytics
  • Other providers integration
  • Artificial Intelligence-Inspired Cost Management.

Using AI to forecast the trends in medical prices and claims patterns, the ability to forecast and make decisions proactively.

Implementing automation to embrace end-to-end processes such as the client-facing portals and real-time data analysis.

Here, a further optimization of pricing strategies via machine learning models and finding opportunities to reduce costs to offer to clients.

The partnership with qBotica has made Expion a leader in the field of healthcare automation, which can encourage other companies to implement corresponding changes.

The Road Ahead

The experience that Expion Health has with qBotica is not the end. The company is now looking at other automation possibilities such as machine learning and predictive modelling with its claims processing system now optimized. This visionary strategy is what makes Expion a leader in the field of healthcare cost management and an example that should be followed by other organizations.

Conclusion

The collaboration between Expion Health and qBotica is an example of how automation can revolutionize the healthcare sector. Since Expion scaled its operations to accommodate 75 claims per day and then 600 percent more day-to-day, the performance of intelligent automation in expanding operational efficiency, precision, and scalability cannot be underestimated.

qBotica can help revolutionize your organization today, should it be willing to do so. Find their answers at this point.