Revenue Cycle Management
TechEdge360 to Revolutionize Healthcare with AI-Powered Automation Software Suite
Automating Complexity, Empowering Clarity
The administrative workload in healthcare continues to grow, with finance teams burdened by manual coding, billing, and claims processes. TechEdge360’s AI x Generative Technologies set a new standard of intelligent automation—transforming RCM from a reactive cost center into a predictive growth engine.
TechEdge360 (TE360), a global leader in healthcare AI and digital transformation, has unveiled its next-generation Revenue Cycle Management (RCM) solution. This innovative offering leverages AI-driven automation to simplify billing processes, minimize claim denials, and reinforce the financial foundation of modern healthcare organizations.
Conventional claims teams at healthcare institutions can only process a limited number of claims per day, given the complexity of disease, treatment, policy coverage, and fraud checks. AI simplifies this workload, enabling teams to focus on genuine, value-driven work, This solution not only automates RCM but also delivers scalable use cases for clients worldwide.
The Next Generation of RCM Efficiency
The solution leverages purpose-built AI models designed to modernize and secure every stage of the revenue cycle, delivering measurable outcomes across cost, speed, and compliance:
Dramatic Cost Reduction
AI-supported claims review and denial prevention lower operational expenses
Exceptional Efficiency
Staff are redirected from manual claims analysis to exception handling, cutting processing time and accelerating reimbursements
Enhanced Accuracy
AI-powered algorithms ensure claims are validated against policies and guidelines with greater precision
Secure & Compliant
HIPAA-compliant, audit-ready systems engineered by global experts in secure AI
From Cost Center to Competitive Advantage
TechEdge360 empowers healthcare organizations to transform RCM operations from manual and reactive to intelligent and proactive. By uniting domain expertise with AI innovation, payors, providers, and insurers can automate administrative burdens—reclaiming time, accuracy, and insight for better care and stronger financial performance.
Featured Projects
Revolutionizing RCM with Automated Patient Entry Processes
One of the US companies specializes in providing revenue management services to healthcare companies. This project focuses on managing revenue related to claims for Durable Medical Equipment (DME) in collaboration with insurance providers. A key aspect of the Revenue Cycle Management (RCM) process is the patient entry stage.
Challenges
- Registering patients manually in the customer portal was time-consuming and prone to errors.
- Ensuring accurate verification of patient eligibility and medical history required substantial effort.
- Checking insurance eligibility in the AIMS portal was labor-intensive.
Solution
- To streamline the patient entry process, the firm implemented RPA automation to handle patient registration and eligibility verification.
- Automated Registration: The bot registers patients in the portal, ensuring accurate data entry.
- Eligibility Verification: The bot validates the Certificate of Medical Necessity to confirm the patient's eligibility and medical history.
- Insurance Check: The bot checks insurance eligibility in the AIMS portal.
Benefits
- Efficiency by 70% : Automation reduced manual effort, speeding up the registration and verification process.
- Accuracy by 98% : The bot ensured accurate data entry and verification, reducing errors.
- Faster Turnaround: The streamlined process achieved faster turnaround times for patient entry and claims processing.
Optimizing Revenue Cycle Management via Payment Processing Automation
Payment processing is a critical step in the Revenue Cycle Management (RCM) process at one of the US clients, where the insurance company sends an ERA 835 file containing claim acceptance details after receiving the patient's payment request.
Challenges
- Ensuring all prior transactions are verified and corrected based on received data.
- Handling various types of transactions such as straight payments, co-insurance/copay, recoupments, balance transfers, adjustments, low payment transfers, and over-payment transfers.
- Managing rejected or denied claims efficiently.
- Ensuring accurate reconciliation and closing of deposits.
Solution
- The bot verifies all prior transactions based on the received ERA 835 file and makes necessary corrections.
- The bot processes transactions for each claim, including straight payments, co-insurance/copay, recoupments, balance transfers, adjustments, low payment transfers, and over-payment transfers.
- For rejected or denied claims, the bot creates a request in the Account Receivables queue.
- Once all payments for a specific ERA file are processed, the bot reconciles the entire deposit and closes it.
Benefits
- Efficiency : Automation reduced manual effort and sped up the payment processing.
- Accuracy: The bot ensured accurate transaction processing and reconciliation.
- Streamlined Rejections: Efficient handling of rejected or denied claims improved workflow.
- Timely Reconciliation: The automated reconciliation and closure of deposits ensured timely financial management.
Get In touch to discuss our Solutions with Techedge360 Experts
Reach out to us through our contact form, and we'll respond to you promptly to ensure you get the support you need. Your success is our priority, and we look forward to partnering with you to become your AI solution provider.
