CMS Claims Conversion

The CMS Paper Claims Electronic Conversion use case accelerator automates the conversion of CMS 1500 and UB04 claim forms to EDI 837P and 837I, respectively.

What is a UiPath accelerator?

UiPath use case accelerators are automation frameworks which are custom-built for specific use cases. These frameworks use best practices and pre-built components which can be modified, expanded, and customized based on the needs of each specific use case and customer, enabling faster time-to-value for your automation programs.

Note: Accelerators are not plug-and-play solutions. The accelerator package codebase contains reusable components that interact with specific systems (e.g., Coupa, etc.). These components are meant to be used as a starting point / example for how such components should be built in an actual implementation.

CMS Paper Claims Electronic Conversion Accelerator

If your billing analysts are creating and submitting paper claims, your cost-to-claim is likely too high. Automating this process enables providers to submit the form electronically, providing an almost real-time response. The result? A cost savings of $1.50 per page, time savings of 50,000 hours per year, and an improvement in AR days.

The CMS Paper Claims Electronic Conversion use case accelerator package assists you in simplifying the conversion from paper CMS 1500 and UB04 claim forms to an electronic format, EDI 837P and 837I, respectively.

You'll find the tools you need to harness the power of Document Understanding for automated conversion into an electronic format. Applying these best practices to your provider organization will help you reduce average handle time (AHT), boost accuracy, and lower overall cost to collect.

Follow these five easy steps:

1. Download the accelerator package.

2. Integrate it into your workflow.

3. Define the intake source.

4. Configure UiPath Orchestrator.

5. Load the 837 into your workflow.

NOTE: The user guide included in this package references “claims form intake.” This reference is the nomenclature for the solution accelerator that converts paper claims into an electronic format. The user guide is more descriptive indicating the use of the solution accelerator “CMS Paper Claims Electronic Conversion.”

The code in this accelerator package processes a claims form in this progression:

1. Email or simple dispatcher

2. Document understanding*

3. Performer

*Human intervention possible through Action Center and optional component to convert to EDI.

A demo video showcasing this use case can be found here: CMS Claims Conversion.

· Get paper CMS1500, UB04 forms from email, SFTP or Share drive

· Classify Document

· Extract Information & Validate business rules

· Exception handling & routing

· EDI 837 conversion