Real RPA Case Studies, Real Verifiable Solutions
The bot automation is vetting for medical necessities matching the minimum requirements from payers’ medical coverage guidance (MCG) vs. medical documentation and examination documents uploaded by doctors in eCW.
Once vetted for medical necessities, the robot submits the referral into eCW. It also indicates the specific traits or needs, Procedures, and Total Number of procedures requested based on the data extraction.
Where does the need to use AI come from?
When-the robot gathers all the medical documentation and submits the referral once for all the procedures., Each procedure appears in the robot’s input in succession as scheduled by doctors;-and the referrals are also created by the business office, not only by the bot;
As a result of these two situations, there is an appearance of a risk of duplicate referrals. The AI comes into play here with its ability to identify this situation. We identify the possibility of checking with AI if the procedures the robot will submit exist in the referral’s reason already submitted.
We are using a standard question and append the procedures to be requested.
Case 1: -GPT identifies the duplicate (the robot throws the BRE -procedures already requested)
Procedures to be requested = Venaseal LEFT SSV + LEFT AAGSV + RIGHT SSV + RIGHT AAGSV
Reasons of existing referrals = APPROVED MNM VSEAL 36482X4 BIL SSV, BIL AAGSV / VARITHENA 36465X2 BIL GSV
=APPROVED MNM VENASEAL 36482 BIL GSV
YES or NO, confidence % and how the confidence is calculated, the procedures from this string ‘Venaseal LEFT SSV + LEFT AAGSV + RIGHT SSV + RIGHT AAGSV with CPT code 36482’ appear in this string ‘APPROVED MNM VSEAL 36482X4 BIL SSV, BIL AAGSV / VARITHENA 36465X2 BIL GSV’. Please consider CPT code 36478 means EVLA; 36475 means RFA; 36482 means Venaseal; 37765 means Phlebectomy; 36465 means Varithena; 36471 means Sclero
YES, confidence 90%.
The confidence is calculated based on the matching of the procedures and CPT codes between the two strings. The presence of “Venaseal LEFT SSV + LEFT AAGSV + RIGHT SSV + RIGHT AAGSV with CPT code 36482” in the first string matches with “VSEAL 36482X4 BIL SSV, BIL AAGSV” in the second string. Similarly, the presence of “VARITHENA 36465X2 BIL GSV” in the second string matches with “LEFT SSV + RIGHT SSV with CPT code 36465” in the first string. The presence of both Venaseal and Varithena procedures with the same bilateral SSV and AAGSV in both strings further supports the confident match.
Case 2 : -GPT confirm that there is no duplicate in submitting the new request (the robot create the new referral in eCW)
Procedures to be requested = Sclero 2 x UGFS LEFT + 1 x UGFS RIGHT
Reasons of existing referrals =Approved internal – Venaseal 36482 x 1Venaseal LEFT AAGSV
YES or NO, confidence % and how the confidence is calculated, the procedures from this string ‘ + Sclero 2 x UGFS LEFT + 1 x UGFS RIGHT with CPT code 36471’ appear in this string ‘Approved internal – Venaseal 36482 x 1Venaseal LEFT AAGSV’. Please consider CPT code 36478 means EVLA; 36475 means RFA; 36482 means Venaseal; 37765 means Phlebectomy; 36465 means Varithena; 36471 means Sclero
NO, confidence 100%.
The procedures mentioned in the first string are UGFS (ultrasound-guided foam sclerotherapy) on both left and right sides, while the procedure mentioned in the second string is Venaseal on the left AAGSV (anterior accessory great saphenous vein). There is no mention of UGFS or sclerotherapy in the second string.
About CampTek Software
CampTek Software is a Full-Life-Cycle RPA SaaS Provider. With industry experience developing and supporting RPA Applications since 2005, we have the expertise to support any Automation initiative you can think of. CampTek will be with you on every step of your RPA Journey. With our unique background, we are qualified to develop and support any RPA Process. We offer Advising Services, Host Support and Bot Support for all production processes. Our unique hosted model offers many powerful advantages including a shorter time to market, 24/7 support and overall lower cost of entry.