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Home > Innovation  > PayorNet – Insurance Coverage Discovery & Robotic Process Automation (RPA)

At CaptureNet, our passion is innovation of technology-driven performance solutions to boost recovery  and improve the patient’s experience with the billing process. Our objective in founding CaptureNet was to disrupt the status quo self-pay world with technology innovations to drive materially improved recovery performance and to respond to the increasing client demand for patient satisfaction with the billing process.

 

Introducing PayorNet

With batch-mining prior to billing, PayorNet discovers, verifies, and then automatically bills found coverage via RPA prior to patient billing, thereby ensuring timely filing and only true patient balances are billed to a patient. Between 7% and 15% of accounts classified by hospitals as balance-after-insurance or straight self-pay at the time of billing have undiscovered insurance coverage – even as those accounts enter the billing cycle. Reasons range from flawed intake at registration to a patient’s failure to share information about additional insurances or retroactive benefits prior to discharge.

Not only does this failure to properly identify third-party payor sources diminish the speed of cash and reduce potential recoveries, it also creates a frustrating patient experience with the billing process. PayorNet offers hospitals a solution to assure discovery and automated billing via Robotics Process Automation (RPA) of found insurance coverage.

 

Business Problems Solved by PayorNet

  • 7% to 15% of all accounts (balance after insurance and uninsured) billed to a patient have insurance coverage.
  • Bills sent to patients where insurance coverage exists results in patient dissatisfaction with the billing process.
  • Hospitals potentially miss out on dollars that would be collected from an insurance company if the balances are billed to the patient.
  • Performing insurance coverage discovery at the pre-statement stage increases the chances of the claim being paid – reducing risk of timely filing.
  • Traditional insurance coverage discovery provides list to work from for hospitals to bill claims. In practice, the hospital does not maximize the value of the insurance benefit information being returned due to lists not being worked timely, completely, or claims being billed incorrectly which causes denials.
  • With Robotics Process Automation (RPA) to bill accounts with found insurance coverage, the claim is processed accurately and timely (next day) which increases the amount recovered and speed of reimbursement for the hospital.

PayorNet Coverage Discovery

  • Performed champion challenges against other coverage discovery products in the market and determined PayorNet’s Coverage Discovery process is industry leading.
  • All commercial and government payors applicable to hospital included in coverage discovery process.
  • Retro Medicaid checks performed on uninsured accounts.
  • Secondary checks for balance after insurance can be performed.

 

PayorNet RPA

Robotic Process Automation (RPA) is a technology powered by virtual robots that work in tandem with a hospital’s existing software applications to automate manual and repetitive tasks. The process does not take the place of human staff but rather uses simple rules and business logic developed to eliminate manually redundant and tedious tasks with less time wasted and more time spent on higher revenue-generating activities.

The PayorNet RPA BOT is customized for each hospital’s billing process, expedites the billing process, assures complete accuracy and timeliness and speeds recovery.

 

Many processes are great candidates for RPA, PayorNet has perfected the process for third-party billing with these benefits:

Accuracy

Extreme accuracy and uniformity – much less prone to errors or typos.

Productivity

Process cycle times are much faster compared to manual process approaches.

Reliability

Bots tirelessly work 24/7 without interruption.

Consistency

Routine tasks are performed the same way each and every time.

Compliance

Bots follow regulatory rules to a tee and provide an audit trail history.

Non-invasive Technology

No disruption to underlying legacy systems, reducing the burden on IT.

 

 

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