Challenge

Automation and healthcare technology adoption are high in US healthcare administration. However, automation of prior authorization (PA) falls significantly behind, with less than 30% adoption across US health plans.

One major US healthcare administrator was struggling with the complexity of PA processing, as experts need access to multiple data points and must maintain regulatory compliance for each state.

Therefore PA decision-making is slow and difficult to automate, resulting in delays in care and patients abandoning treatments.

Solution

Partnering with UiPath, Rainbird introduced its Decision Intelligence platform including its extended knowledge graph and reasoning technology, to the clients’ RPA program, which allowed them to codify human PA expertise and automate complex decision-making.

UiPath’s RPA focused on gathering data and completing linear tasks and then called on the Rainbird platform to perform all complex reasoning, resulting in a seamless healthcare technology solution.

Rainbird provided an effective separation between process tasks and decision-making, which sped up the entire PA cycle significantly.

Outcome

The resulting Rainbird-UiPath hybrid model executes faster and has reduced build time by 95%.

The model is more consistent, delivering accurate HIPPA-compliant decisions every time with explainability, reliability and traceability built in. What’s more it is easier to maintain, cheaper to operate, and more reliable.

To find out how your organisation man benefits from the Rainbird Decision Intelligence platform, talk to an expert today.