Conversational AI and Intelligent Automation Reduce Payer Denials

Challenge

When a notable health system was experiencing millions of dollars in insurance claim denials, they chose Guidehouse to advise on task optimization with intelligent automation starting with 13 of its business functions.

Solution

Using Automation Anywhere's Process Discovery technology and subject matter expert consultation, Guidehouse gathered more than one million data points from the client and gained a thorough understanding of several ineffective processes that presented powerful use cases for intelligent automation. With these insights, Guidehouse developed a roadmap to streamline and automate high-value use cases across the health system’s business functions.

Impact

One stand-out use case involved the client's insurance eligibility verification process. Guidehouse’s analysis found that patients were mistakenly giving incorrect insurance providers, causing the health system to receive eligibility denials.

Guidehouse solutions led to significant process improvements for this client. According to Guidehouse partner Michael Duke, “We impacted over $44 million in denied accounts needing rework by optimizing the client's core tech and launching conversational AI with robotic process automation to provide a unique automation experience for the client team.”

Download Case Study