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R1 RCM efficiently automates over 32M tasks annually using RPA

ABOUT

R1 RCM is a leading provider of technology-enabled revenue cycle management services which transform a health system’s revenue cycle performance across settings of care.

THE CHALLENGE

The nature of R1’s business is very labor-intensive and transactional with many repetitive tasks. Additionally, R1 staff utilizes many of the core systems already in use within a client’s organization, which poses unique challenges in applying R1’s standardized, revenue cycle processes. While R1 leverages its built-for-purpose, integrated technology platform to allow for standardized workflow across these disparate systems, there can still be the “last mile” problem of actually transacting in these systems themselves. Robotic process automation (RPA) represented a way for R1 to automate routine tasks without needing to engage each client’s IT resources to implement additional interfaces or scripts.

32M+

Tasks automated annually

300+

"Digital Workers" in production

75+

Health systems in 100 + locations connected

Sean Barrett

"We selected Automation Anywhere’s RPA solution due to its ability to scale quickly and its bank-grade security and encryption which is critical in the healthcare industry."

Sean Barrett, Vice President of Digital Transformation quote

THE SOLUTION

After a rigorous request for proposal (RFP), R1 selected Automation Anywhere as a partner due to ease of use, scalability, security/encryption, and their products’ ability to run across different platforms. A Center of Excellence (COE) approach under the company’s broader Digital Transformation program allowed R1 to rapidly scale while ensuring high-quality software engineering standards were applied to the RPA program. This also enabled R1 to reliably manage the vast amount of transactions performed on behalf of clients. Combining R1’s deep operational expertise with RPA allowed the company to bend the administrative cost curve in healthcare and meet the operational demands.

Processes Automated

Insurance Claims Processing

Insurance Claims Processing

Procedure Prior Authorization

Procedure Prior Authorization

Payment and Transaction Posting

Payment and Transaction Posting

 

THE WHOLE STORY

R1 started by automating their core business process: claims processing. It is important to note that while the company’s staff are still a very important part of this process, many of the steps requiring manual interventions are now automated. This is a great example of RPA enhancing staff productivity. The company deployed RPA to automate various steps. Prior to claim submission to an insurance company, validations or “edits” are applied to increase the likelihood of payment. Without automation, to resolve errors flagged by the validation process, information from various systems is typically gathered manually. This process of information gathering and resolving the “edit” is now automated through RPA saving significant staff time and effort. After the claim is successfully submitted to the insurance company, its status must be checked at regular intervals to determine if any intervention is needed to obtain payment. Some industry standards exist to perform this process; however, R1 realized the information obtained generally lacks the detail required to resolve the claim issues. Today, these status checks are automatically obtained through RPA and imported into R1’s proprietary workflow platform to ensure only claims requiring intervention are sent to staff to address.

THE FUTURE

R1 operational stakeholders realize the value of RPA and they’re bought into the program. The company continues to discover net new automations, extend existing ones for increased value to customers, and develop a robust RPA pipeline. Ultimately, R1 aspires to scale their automation COE as part of their digital transformation effort.

Mike Wallace

"We know automation is critical to our ability to scale, and we saw RPA produce significant efficiencies in our day-to-day operations."

— Mike Wallace, Vice President, Software Engineeringquote

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