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Taking the Pains Out of Healthcare Customer Service
- New EMR Record Creation -- If the patient’s records can’t be located, then the next phase of automation for this process is the creation of the new EMR. Simple navigation assistance to the correct page for record creation may be an automation opportunity. Another may be copy/paste from legacy systems into the new or preferred EMR systems. The opportunity for time savings in this process can be 30 seconds to 120 seconds per event. As complex as it might seem, with AI, ML, and NLP, a large portion of new EMR creation can be fully automated in any communications channel.
- Credit Checks -- If the patient doesn’t have insurance, then some providers will accept a personal guarantee of payment in advance of scheduling an appointment. Usually, these providers require credit information to decide if they’ll offer a personal guarantee to the patient. In these cases, the robot can automate part or all of this process by reading the information contained in the EMR and using it to systematically interrogate credit agency websites for credit-score data. Further, the robot can record this information automatically in the EMR. The use of admin-triggered automation for this process can save between 40 seconds and 180 seconds per event.
- Coverage Determination -- If the patient does have insurance, then an admin will often need to determine if the provider will cover the requested services. The robot can read information from the EMR and use this information to seek a coverage determination. Sometimes, this may require the admin to provide the robot with the specialty or procedure code for the coverage determination. Once the relevant data and metadata is assembled, the robot can access the payer’s systems and retrieve an explanation of benefits for the patient to read. The use of admin-triggered robotic automation for this process can save between 45 seconds and 75 seconds per event.
In some cases, coverage determination may depend on prior authorization (PA). The logic is too complex to depict on the flow chart; however, the automation of processing PAs can save multiple minutes per event with robotic copy/paste functions between the EMR and the PA interface.
- Appointment Availability & Setting Appointments -- Finding an open appointment in large healthcare systems can be complicated by the existence of multiple EMRs and/or multiple scheduling systems. The appointment information may be contained in the EMR itself or in one or more appointment scheduling tools. A healthcare provider can leverage software robots to handle any of these situations. Often, several systems will require the appointment updates and therefore the data needs to be synchronized across all necessary enterprise systems. The aggregate time savings opportunity for this phase of the appointment-setting process can be between 120 seconds and 240 seconds per event.