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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, validate, 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 designated group folder and extracts the accompanied PDF. Using OCR/ICR, the standard PDF data is extracted and then validated 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.