Bot automation helps improve Medicaid outcomes

Robots in the workforce? It’s not sci-fi or futuristic. “Digital workers” or software robotics are here and ready to improve Medicaid maintenance and operations. Robotic process automation, or RPA, is just one of the many technologies Optum is advancing for health care.

RPA is software that can automate repetitive tasks. It’s artificial intelligence that can sign into an app or copy and paste data — just like humans.

For our state partners, this is game-changing. No longer will time-consuming, manual processes delay or disrupt the work of making sure people can get the Medicaid benefits, care and services they need. Team members can be freed up to work on other priority or more complex projects.

For example, one of our state partners relies on independent assessments to determine Medicaid eligibility for certain services and supports. Assessors conduct interviews that include as many as 1,000 questions. When they lack a strong internet connection, the assessor is unable to enter answers to all those questions into a database in real time.

They must save the information in a form and then later go back and input the data. It’s a labor-intensive process that can take many hours. And there may be an increased risk of data input errors. Internet connectivity issues hinder about 5% of a claims assessor’s cases.

With RPA, a poor connection does not disrupt the eligibility determination process for our state partner’s Medicaid agency or its employees.

“With this bot, when an internet connection is lost or unavailable, the assessor still fills out a PDF form and saves it. But there’s no longer a need to manually re-enter the answers,” says Anurag Kumar, director of technology for Optum State Government Solutions.

Bots offer nearly 100% accuracy

Using a plug-in incorporated by the automation engineering team, the bot opens the PDF, reads all the data, copies it and loads it into the system. It relies on AI, optical character recognition and business rule mapping logic to accomplish this task.

The program looks at every pixel on the screen — the color, the font — to see if responses are selected or not selected.

It’s also designed to account for new questions added to the agency’s system. The bot will read and identify what content is required, even if it’s out of order in the PDF, and enter it correctly into the system.

“Imagine a scenario where the assessor returns to the office and calls up the bot and says, ‘Please update all my assessment details back into the portal.’ The bot takes over and updates everything,” says Kumar.

An automated alert notifies the assessor when the work is completed. It takes about 5 minutes. Hours are saved. More beneficiaries can be interviewed. Errors are avoided. The RPA bot improves the accuracy of information by nearly 100%.

“By identifying clogs in the automation pipeline, we can help simplify many manual processes related to Medicaid business,” says Kumar. “Ultimately, the work will improve accuracy, save money and enhance the overall system for our customers.”

Across health care, RPA can be used to manage electronic health records, streamline claims processing and even simplify and manage patient appointments.

To learn more about applying new M&O innovations in your state, contact us today.