Problem Statement

Claim edits create manual rework before a claim can go out the door, and edits left unresolved either delay submission or, if missed, produce avoidable denials that erode the clean claim rate and push out cash collection. When a Medicare inpatient exhausts their Part A benefit days mid-stay, the billing has to reflect it: the Part A exhaustion details must be captured and the stay split into the correct Part A and Part B claims. Getting the day utilization and the resulting claim split right by hand is detailed, error-prone work, and a wrong split bills Medicare incorrectly.

Automation Solution

This automation retrieves Medicare inpatient day utilization details from the Medicare portal, updates Part A exhaustion information in Epic, and generates the appropriate Part A and Part B claims to support accurate billing.