Claim Statusing in Revenue Cycle System - RPA Automation

Overview

This work focuses on building an end-to-end RPA workflow using UiPath for medical claim statusing in Revenue Cycle Management. The system automates repetitive and time-consuming manual steps involved in checking claim status across multiple portals and consolidating results for downstream processing.

The goal is to reduce manual intervention, improve turnaround time, and ensure more reliable claim tracking, especially in high-volume healthcare environments.

Motivation

Claim statusing is often delayed due to multiple real-world constraints such as manual portal navigation, login friction, multi-factor authentication, and human errors during data entry. These delays cause claims to accumulate, leading to slower reimbursements and operational inefficiencies.

Automation becomes necessary to streamline this workflow and ensure faster resolution of claims.

Workflow Description

The automation process replicates the manual workflow in a structured manner. It logs into insurance portals, navigates through authentication steps, enters patient details, and retrieves claim status results such as PAID, DENIED, or CLAIM NOT FOUND.

Once the status is retrieved, the system records the output into structured Excel sheets and downloads associated receipts where applicable. An optional LLM-based summarization layer is used to generate concise interpretations of the claim status for easier review.

Data Sensitivity and Compliance

The system handles Protected Health Information (PHI), which requires strict compliance with healthcare data regulations. Data protection is treated with high priority at every step of the workflow.

HIPAA defines the rules for handling, storing, and processing patient data securely. It ensures that all operations on PHI follow standardized safety practices.

In addition to HIPAA, Business Associate Agreements (BAA) act as formal contracts between entities handling PHI. These agreements ensure that every party involved adheres to the same security and compliance standards. Together, HIPAA and BAA create a secure framework for processing sensitive healthcare data.

Technical Learning

Working with UiPath provided practical exposure to robotic process automation beyond traditional AI systems. It enabled the development of resilient workflows capable of handling dynamic UI changes and real-world edge cases.

The system also revealed opportunities where AI components, such as LLM-based summarization, can enhance traditional RPA pipelines.