Referral Management - Local Coverage Determination Lookup
Perform Local Coverage Determination (LCD) lookup for cases in predefined work queues
DOMAIN
Revenue Cycle Front
FUNCTION
Referral Management
Category
Referral Intake, Routing, and Submission
Status
Live
AUTHORING ORGANIZATION
Deaconess
PERFORMANCE METRIC
Denial Write offs
Automation Tool
UiPath
TECHNOLOGIES
RPA
Applications
EPIC
Vitalware
HB | PB
N/A
Automation value
(as reported)
147760
Problem Statement
Referrals must be received, validated, and acted on before a specialist visit, because many payers require an authorized referral on file or the visit denies. Some services have to be checked against Medicare's Local Coverage Determination rules to confirm medical necessity before they proceed, or the claim denies as not medically necessary. Performing each LCD lookup by hand for cases in the work queues is repetitive, prescribed research that is easy to backlog.
Automation Solution
This automation performs the Local Coverage Determination (LCD) lookup for cases in the predefined work queues to confirm medical-necessity coverage.
Automation Resources
PDDs, Process Flows, Presentations, and Assessments
Deaconess_MedNec_PDD_FinalApproved
PDD
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Related Automations
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Problem Statement
Referrals must be received, validated, and acted on before a specialist visit, because many payers require an authorized referral on file or the visit denies. Some services have to be checked against Medicare's Local Coverage Determination rules to confirm medical necessity before they proceed, or the claim denies as not medically necessary. Performing each LCD lookup by hand for cases in the work queues is repetitive, prescribed research that is easy to backlog.
Automation Solution
This automation performs the Local Coverage Determination (LCD) lookup for cases in the predefined work queues to confirm medical-necessity coverage.
Automation Resources
Deaconess_MedNec_PDD_FinalApproved
Related Automations
Comments