Facets check verification and printing using Pega RPA

FINBOT - Robotics process automation solution for Facet check verification and print release

Inspiration

Once healthcare claim is paid and updated in Facets, the check has to be printed by vendor. The validation and confirmation to vendor usually takes 2 days and after that vendor takes a day or two to print the check and mail it. The checks batched on Friday and Saturday will not be reviewed until Monday and the entire process to mail a check will take 5 days. If the validation steps are eliminated from Facets then it will lead to incorrect checks being mailed.

What it does

Robotic Automation solution compares the Facets totals and check numbers for Explanation of benefits (EOB) and Explanation of payment (EOP) against the Broadridge file (vendor) and if the total matches, the print jobs will be released by automation. The solution sends an email notification to alert the Finance team if there is any discrepancy in totals or empty files so as Finance team can further investigate and fix the issue.

How we built it

Email listener would listen to email from Broadridge mail box and would automatically create cases in Pega. Pega extracts data from emails and attach the data to the case. Further down Pega robotics process automation solution validates EOP and EOB amounts in Facets and Broadridge applications and disburse the check.

Challenges we ran into

Broadridge is external vendor application and does not provide any real time api's for straight-through processing logic to match the check number, amount etc. Broadridge UI Matching logic

Accomplishments that we're proud of

This is an RPA solution which will be triggered when Broadridge sends an email with EOP and EOB amounts in mail attachment and process the files on a defined schedule. The Audit mail will have the jobs released, the total sum for EOB and EOP for traceability. Robust case management and end to end digital process automation reducing manual effort by 92% Management dashboards and reporting provides end to end visibility

What we learned

Speed to market Increase velocity of development using Pega robotic process automation Scale up robotic solution based on volumes Efficient usage of robot licenses

What's next for Facets check verification and printing using Pega RPA

This solution is currently built for commercial line of business and we want to expand this solution capabilities for small and large business groups in HealthCare.