Healthcare / RCM / Applied AI
Healthcare Insurance Verification & RCM Automation
300 patients/day · replaced 7 FTEs
The problem
In the US healthcare system, clinics and doctors claim insurance, which requires a heavy, manual verification setup. The client, an Indian company handling RCM and billing for US patients, had a large manual team dedicated to verifying insurance data.
Verification requires logging into disparate payer portals to check whether a patient's insurance is active, and extracting complex data like copay, coinsurance, and deductibles — highly labor-intensive and error-prone.
The approach
EHR integration
Built the foundational integration with eClinicalWorks to automatically extract daily appointment schedules and patient data, eliminating manual reports.
Multi-modal extraction engine
A dynamic pipeline that adapts to each payer portal — combining direct APIs, HTML parsing, Selenium web automation, and Chrome extensions to access the data.
AI agentic parsing
An AI agent layer using LLMs with structured JSON outputs parses irregular portal data to reliably extract copay, deductible, coinsurance, and active status.
Closed-loop automation
Structured verification results are written back into patient records in eClinicalWorks via UiPath and APIs.
The results
OutcomesRelated case studies
All work →Start a conversation
Want results
like this?
Tell us what you are trying to build, automate, or improve.
We respond within one working day.