An example of innovative work recently occurred in a collaboration between the IU Health Robotic Process Automation (RPA) team and Utilization Management (UM) team.

They came together to see if RPA could improve a tricky process surrounding the timely attestation of Notice of Admission (NOA) for certain Medicaid inpatients.

The UM team is responsible to inform the Family and Social Services Administration (FSSA) when their Medicaid patients become inpatients. Until recently, they have had to do so manually for each patient admitted to an IU Health hospital by providing Notice of Admission manually to the State’s website.

Regulations dictate that if a patient is admitted as an inpatient, IU Health must inform Medicaid by 5pm that same day or else it is an automatic denial. The intricacies of this manual process have always required a lot of hard work and stress for UM teams so no patient with Medicaid is denied coverage.

The RPA and UM teams sought to improve this process. They arrived at a solution that automated the NOA process.

The RPA team utilized a program called Blue Prism that works as a “bot” behind the scenes to check and update the Medicaid website three times a day, removing the need for UM team members to manually load NOA’s timely to CoreMMIS.

The NOA automation is part of UM’s strategic plan to go from “volume to value.” This innovation helped solve a payer process problem – Medicaid’s short NOA deadline – that may not impact a high number of patients, but is very high risk from a reimbursement perspective.

As often the case with process automation, there are several benefits from this work. Team members can now freely focus on more strategic work, reducing stress and increasing engagement.

Published On: August 30th, 2021 / Categories: Healthcare, Automation /

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