Problem Statement

Claims must be adjudicated against the plan's rules, and some require a staff member to determine the correct Provider ID before they can process. Once staff have assigned the IDs in a worklist, each one still has to be keyed into the matching claim in Facets and the claim processed. The right action depends on whether an error message comes back. Doing this transcription and processing by hand is repetitive and exact-match work where a mis-key sends the claim down the wrong path.

Automation Solution

This automation pulls each claim in Facets, pastes the staff-assigned Provider ID, processes it based on whether an error message is returned, and produces an output file matching each claim number to the Provider ID used.