Prior to the implementation of the automated solution, physicians would receive blank forms to be filled, signed, and sent back to Quadax for review. This tedious process took valuable time away from the physician’s day. Further, if physicians were unable to timely complete the Statement of Medical Necessity (SOMN) and insurance companies did not receive SOMNs in a short time frame, there was a risk of insurance denying the claim and missing the reimbursement window.

Proven to be a quick automation win for Quadax, Reveal Group began work on a Statement of Medical Necessity (SOMN) process. The manual process included the following high-level steps:

• Read medical test results from an internal portal
• Download the proper SOMN PDF document (choice of six different documents)
• “Stamp” or check boxes on the SOMN form, based on the test data
• Submit to the portal for Quadax review
• Route SOMN to physician for signature
• Send form to insurance

The RPA solution automated the first four steps of the process listed above.

The team determined that a combination of Browser Automation, UI Automation, and Surface Automation using Blue Prism was the best approach to automating the SOMN process. Surface Automation was heavily utilized in this project to interact with the PDF versions of SOMN forms through Adobe Acrobat Reader. With surface automation, each checkbox was spied based on keywords located around the box, and extensive testing was done on each form and checkbox to ensure surface automation was a reliable solution.

Reveal Group delivered the automation to production in 7 weeks. The automation has a 98% pass rate, with only 2% of cases failing due to system issues. The process covers 128+ insurance payers, including 10 payers with the highest volume of cases. The manual stamping process was not implemented prior to the automation being built, but if it were, Quadax would have likely had to allocate approximately 2,772 annual hours to incorporate the task into their daily activities.

Quadax impressed one of its largest clients with the new automated process, improving customer satisfaction and turnaround time. Digital transformation has become a major driving force for Quadax, unveiling the opportunity to expand on their RPA program, and tackling additional business challenges.

Quadax is a healthcare technology and services company that guides healthcare providers through revenue cycle management by maximizing healthcare reimbursement, improving operational efficiency, and optimizing their financial performance. Quadax embraces innovation and was eager to launch their first RPA initiative. Reveal Group experts assessed Quadax’s automation pipeline and identified a viable opportunity that did not require extensive process reengineering, successfully delivering Quadax’s first RPA solution to production.

• INDUSTRY: HEALTHCARE AND SOCIAL ASSISTANCE
• OPERATING IN: CLEVELAND, OH