Back Industry: Healthcare

Validating Medicaid for Newborns

COVID-19 Challenge

Recession has caused millions to lose their commercial health benefit

A large NYC Hospital has over 20 healthcare administrators working to research, verify, and change the newborns' insurance ID to state-based Medicaid to ensure there is no gap in total care.

This process is vital as it ensures that the parents do not have a heavy financial commitment to services and that they, as well as their newborn, receive all the included benefits of Medicaid.

Solution

The hospital decided to automate this process with a software robot that starts by routing Medicaid alert emails to a defined group folder and extracts the accompanied PDF. Using optical character recognition (OCR)/intelligent character recognition (ICR), the standard PDF data is extracted and then confirmed against the newborn's patient profile.

The insurance ID is then automatically updated to Medicaid and all notes and cross-platform workflows are closed. If there is an exception in the process, a task is created in the workflow for manual intervention.