Learn How Thoughtful Automates Medicaid Eligibility Verification for Your Behavioral Health Practice

Medicaid is the largest coverage program in the US and remains a critical support system for those who need cost-effective, high-quality coverage. However, many healthcare providers struggle to manage Medicaid eligibility verification effectively, leading to denials and further delays in claims processing. In fact, according to the 2021 CAQH Index, eligibility and benefits verification is currently the most expensive administrative transaction for healthcare providers. 

Luckily, robotic process automation (RPA) with Thoughtful can help. Using specialized software, RPA can automatically check patients' Medicaid coverage and determine their eligibility for various services. Here are some of the ways automation can improve Medicaid eligibility verification across health systems. 

Decreased Effort and Time

Automation can speed up operations and reduce the labor burden on administrative workers. For example, RPA bots can work every day of the year, 24 hours a day, and on average, can complete tasks 20 times faster than a human. 

Moreover, RPA bots are impervious to human error. They perform the same actions each time with 100% accuracy. By contrast, human workers get tired or distracted and make potentially serious mistakes. Of course, human workers are responsible for rectifying these mistakes later down the line, requiring more time and effort. RPA gets around this by ensuring mistakes don't happen in the first place. 

Increased Authorization and Approvals

RPA bots can verify the patient's eligibility and benefits before the appointment takes place. They can do this by verifying patient information during the appointment scheduling phase, which can also be automated with RPA bots. Essentially, bots can say one step ahead in denial prevention by ensuring pre-authorization activities occur ahead of time. 

Automation bots can also periodically check coverage and benefits to ensure patients and providers don't receive any unpleasant surprises. For example, the bot can check or verify patient records to confirm any changes like marital status don't impact coverage. 

Decreased Billing Cycles

With increased authorization and approval rates, denials plummet. This means healthcare providers avoid costly delays that impact their cash flow and frustrate customers. In addition, automation reduces the typical invoice lifecycle, including reducing errors, enabling the healthcare organization to benefit from faster payments. RPA also dramatically reduces paper-based transactions and their associated costs. 

Lastly, by reducing the billing cycle, healthcare providers can improve patient timelines and, as a result, boost patient satisfaction. 

Increased Staff Productivity

RPA bots spare humans from working on dull, repetitive tasks, meaning they have more time to focus on tasks that demand their creativity and valuable insights. With Medicaid eligibility verification being so expensive and time-consuming today, automating this process can have a dramatic impact on staff productivity. Workers spend less time correcting errors and switching between various IT systems to complete tasks. RPA can automate the end-to-end data entry and transfer processes involved in Medicaid eligibility verification and claims processing. 

Crucially, when workers' time is freed up, employee morale skyrockets, and healthcare organizations benefit from a more engaged workforce. 

Wrapping Up

Medicaid eligibility verification is a critical task in health systems, but it's also incredibly costly and time-consuming. With healthcare organizations under more financial stress than in previous years, finding a way to reduce the burden of Medicaid eligibility verification is paramount. RPA offers a way to get ahead of these challenges. 

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Published On:

August 22, 2023

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