NHC is a trusted partner in comprehensive senior care. With over 50 years of experience, they provide a continuum of care that includes skilled nursing, assisted living, independent living, homecare, hospice, and specialized services like memory care, geriatric psych acute care, pharmacy, and rehabilitation.

Implementing Robotic Process Automation (RPA) for Medicaid eligibility verification has been a transformative step in optimizing both accuracy and efficiency within our revenue cycle operations. Prior to automation, our teams spent significant time manually keying data into systems, reviewing eligibility responses, and validating monthly member responsibility amounts. This process was not only time-intensive but also prone to human error.

With the introduction of RPA, we now have a streamlined, standardized approach that ensures eligibility is verified consistently and promptly. The automation captures changes in coverage status and monthly member responsibility. Significantly reducing the risk of missed updates that can impact billing accuracy. In addition, this process loads the verification data into MatrixCare Resident Documents ensuring we have documentation for future claims payment reviews and potential recoupments.

 One of the most impactful benefits has been the shift from manual review to an intelligent change-report model. Instead of reviewing every record, end users are now provided with a focused report that highlights only those members with changes to eligibility or financial responsibility. This targeted approach allows staff to concentrate their efforts where they are truly needed, dramatically improving productivity while maintaining compliance and accuracy.

 Overall, RPA has enabled us to reallocate valuable staff time away from repetitive data entry and toward higher-value activities, such as issue resolution and proactive account follow-up. The result is a more efficient workflow, improved data integrity, and a stronger foundation for managing RCM activities effectively.