Reducing Claim Rejections through Intelligent RPA Automation

• >95% First-Pass Acceptance Rate
• Up to 50% Faster Payment Turnaround
• 80% Reduction in Manual Review Time

Overview

A multi-state health system faced persistent claim rejections and slow reimbursement cycles. Manual reviews, payer portal lookups, and fragmented follow-ups fueled revenue leakage. GeBBS deployed an RPA-driven Claim Status Extraction & Validation solution to automate status checks, classify rejection causes, and trigger rapid resubmission—improving cash acceleration and denial prevention at scale.

Opportunities & Challenges

The client’s manual claims workflow resulted in:

• 15–20% rejection rates across payers
• 7–10-day delays per claim due to rework and follow-ups
• Limited visibility across the claim lifecycle, causing repeat work
• Staff time diverted to low-value status checks and data entry

Solution

Automated Claim Status Extraction & Rejection Management
GeBBS implemented an RPA solution to:

• Continuously extract status from payer portals and clearinghouses
• Classify rejections (eligibility, coding, missing data) via business rules
• Trigger rule-based fixes and automatically resubmit corrected claims
• Route exceptions to SMEs for targeted audit or payer escalation

Outcomes

• Rejections Reduced: 15–20% → <5%
• First-Pass Acceptance: >95%
• Manual Review Time: Reduced by 80%
• Payment Turnaround: Up to 50% faster
• Operational Visibility: Real-time tracking and analytics across claim lifecycle

Key Takeaways

• Claim status automation eliminates lag and manual rework.
• Rules-based validation strengthens compliance and first-pass yield.
• Exception-only routing frees teams to focus on denial prevention.

Conclusion

By automating claim status extraction and rejection handling, GeBBS helped the client achieve a 95%+ first-pass yield and materially faster cash cycles—transforming back-end throughput and revenue realization.

Client Testimonial

“GeBBS’ automation streamlined our claims validation end-to-end. Turnaround is faster, rejections are near zero, and our teams focus on complex denials—not status chasing.”
— Director, Revenue Cycle Operations