RCM Brain Weds AI and Predictive Analytics
Company Size
11-200
Region
- America
Country
- United States
Product
- WebFOCUS Portal
- InfoAssist
- InDocument Analytics
Tech Stack
- Artificial Intelligence
- Machine Learning
- Predictive Analytics
- Data Visualization
- Robotic Process Automation
Implementation Scale
- Enterprise-wide Deployment
Impact Metrics
- Cost Savings
- Productivity Improvements
Technology Category
- Analytics & Modeling - Predictive Analytics
- Analytics & Modeling - Real Time Analytics
- Application Infrastructure & Middleware - Data Exchange & Integration
Applicable Industries
- Healthcare & Hospitals
Applicable Functions
- Business Operation
Use Cases
- Predictive Maintenance
- Process Control & Optimization
- Root Cause Analysis & Diagnosis
Services
- Data Science Services
- System Integration
About The Customer
RCM Brain is an AI-driven revenue cycle rules engine and workflow automation platform. It uses artificially intelligent workflow bots to connect data and execute tasks across legacy billing systems, clearinghouses, and payer websites. The company was founded to simplify the revenue cycle management (RCM) workflow with the help of BETH, an AI system that leverages machine learning technology and Information Builders’ WebFOCUS business intelligence (BI) and analytics platform to boost the efficiency and productivity of claims-processing staff. The system combines an AI rules engine and robotic process automation with data processing and analytics technology from Information Builders.
The Challenge
RCM Brain needed a flexible analytics solution with comprehensive data management, data visualization, and predictive analytics capabilities that could be embedded into a larger software platform. The revenue cycle management (RCM) process that medical providers use to track revenue from patient visits is complex and error-prone, leading to high administrative costs and revenue leakage. RCM data is spread among various systems, making it difficult to create comprehensive reports. The challenge was to automate this process and reduce the costs associated with inaccurate medical claims.
The Solution
RCM Brain used WebFOCUS Portal to build a series of analytics dashboards that permit RCM workers to visualize and drill into claims data through dynamic charts. The system can reverse-engineer payer denials and discover patterns in the data, gradually building a predictive layer to intercept and interrogate errant claims prior to submission to the payer. WebFOCUS also performs root-cause analysis to surface errors in the claims billing process. It provides visual controls over the AI processing engine, allowing managers and executives to monitor RCM workflows and obtain a holistic view of RCM activities. The company plans to enhance the system with new types of analytics, including summarized content and an ad hoc analytics environment anchored by InfoAssist.
Operational Impact
Quantitative Benefit
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