Intelligent Document Processing & RPA-Based Claims Automation for Hospital Insurance Processing

Synopsis

A large hospital network struggled with an overwhelming volume of insurance claims, resulting in delayed processing, high rejection rates, and manual bottlenecks. DaCentric Technologies implemented an Intelligent Document Processing (IDP) and Robotic Process Automation (RPA) solution to streamline the claims workflow—from document ingestion to validation and submission—enabling faster, more accurate, and transparent claims management.

Customer Background

The client was a prominent hospital group operating multiple branches, each handling numerous insurance-based patient admissions daily. Every claim required managing several types of documents, including admission forms, diagnostic reports, invoices, physician notes, and insurer forms—often submitted in a mix of digital, scanned, or handwritten formats. Claims verification involved coordination between departments such as medical records, billing, and insurance liaison, with manual checks for completeness, eligibility, and accuracy. The entire workflow was time-intensive and error-prone, leading to delays and financial inefficiencies that affected the hospital's cash flow.

Challenges

The hospital faced significant hurdles in maintaining speed, accuracy, and compliance in its claims process. Documents arrived in varying formats—some scanned poorly or containing illegible handwriting—which required extensive manual effort to clean and verify. Staff members spent hours checking every claim for missing data, patient eligibility, and signatures, which slowed the overall turnaround time. The lack of standardized processes often caused back-and-forth communication between departments and patients to correct incomplete documentation. As a result, claims were frequently delayed or rejected by insurers due to mismatched data or inaccuracies. Moreover, management lacked real-time visibility into the claims pipeline, making it difficult to track progress, identify bottlenecks, or measure performance metrics effectively.

Our Solution

To overcome these challenges, DaCentric Technologies deployed a robust Intelligent Document Processing (IDP) and RPA-driven workflow tailored for healthcare insurance operations. The system began by using Optical Character Recognition (OCR) and machine learning algorithms to extract data from diverse document types, including handwritten and scanned forms. Automated validation rules were implemented to check for patient ID matches, required fields, and missing signatures, ensuring data consistency and completeness. RPA bots were designed to handle repetitive administrative tasks—such as routing documents, populating insurer forms, and cross-verifying records with the hospital's internal databases—while simultaneously triggering alerts for any discrepancies. The entire process was orchestrated through an automated workflow that seamlessly managed every stage—from document receipt and validation to review, submission, and tracking. Dashboards were introduced to give management real-time visibility into claim status, processing speed, and rejection causes. Insights from these dashboards enabled continuous improvement through feedback loops, allowing the hospital to identify recurring errors and refine upstream documentation processes.

Results & Benefits

Conclusion

By integrating Intelligent Document Processing and RPA, DaCentric Technologies transformed the hospital's insurance claims operations into a streamlined, accurate, and transparent system. The automation not only minimized manual workloads and reduced rejection rates but also strengthened financial stability through faster reimbursements and enhanced process visibility.