Automation eliminates manual data entry between case management and insurance policy admin platforms. It monitors work queues for new policies, and extracts and uses business rules to transform policy application data (e.g., type, payment plan, address). The information is loaded into the target admin platform for underwriting. MI operational reports are generated for completed cases, exceptions, and policy statistics.
While not diagnosing a medical condition, the automation uses patient data from medical evaluations performed by registered nurses (RN). Applying rules to medical codes entered by the RN, it sets the patient’s status as “normal” or “SIA”, and, as applicable, sends SIA alerts to the individual members of the patient’s direct care team advising that they need to immediately get to their patient. It results in improved patient care, services for their families, and revenues for the organization in support of its mission.
Automation enables immediate action on referral. Using simplified data-entry screen, intake team and referring physician work together to load the patient’s medical data into the system (e.g., diagnoses, demographics, insurance coverage, circumstances). Using rules and workflows, automation (1) identifies follow-up admission tasks and required face-to-face visits, (2) assigns the direct care service team by location, (3) prepares electronic medical record and (4) provides draft clinical notes to care team for review and submission.
Automation digitized distribution, collection, and review of timesheets, and eliminated redundant manual data entry. Timesheets are generated from planned provider schedules and also on-demand for unscheduled services. Medical team members receive and fill out their timesheet and are sent reminders to complete them as needed. CPT coding is applied and checked based upon services provided. Finished timesheets are reviewed by Billing before getting uploaded into NetSmart.
Read how this organization built an automation that uses NetSmart electronic medical record (EMR) and the organization’s data warehouse in order to identify patients being served. Next, it uses myAbility to evaluate patient’s current and prior circumstances to determine eligibility for Medicare insurance. The results are added to the patient’s EMR for use by claims and billing teams. Also, non-Medicare insurance outcomes are flagged for review by the Billing team.