Why Manual and Robotic Based Claims Processing Falls Short in Today’s Complex Healthcare Landscape

With rising claim volumes, complex regulations, and pressure for faster reimbursements, manual processes—and even basic automation like RPA—can’t keep up. 

The Unsustainable Costs of Manual Adjudication 

Manual processing is plagued by inefficiencies: 

• High Administrative Costs: Large teams are needed for repetitive reviews. In the U.S. healthcare system, total net administrative costs account for 7–10% of the country’s GDP.  

Sources: [Health System Tracker], [Excessive Administrative Costs]     

• Slow Turnaround: Multi-step manual checks delay reimbursements. The average turnaround time is 30 days with manual adjudication. 

  Source: [Insurance Payment Turn Around Time] 

• Error-Prone: Human mistakes lead to denials, underpayments, and costly rework. The industry average error rate in manual adjudication is 5%. 

  Source: [The basics of the Robotic Process Automation in Insurance Claims] 

  
  

Hidden Risks of Outdated Methods 

• Compliance Gaps: Inconsistent reviews risk compliance violations. 

• Prompt Pay Penalties: Delays in claim processing can lead to penalties from payers for not meeting timely reimbursement standards—further increasing provider costs. 

• Data Fragmentation: Siloed spreadsheets and disconnected tools cripple decision-making. 

Why RPA Isn’t the Solution 

While RPA bots offer automation, they introduce new challenges: 

• Limited Speed: Fragmented workflows still slow down overall turnaround time (TAT). 

• Scaling Costs: More licenses and hardware drive up overhead expenses. 

The Future: AI-Powered, Intelligent, End-to-End Automation 

The healthcare industry needs systems that combine business-driven rules with faster processing and scalability, not just band-aid solutions. 

KS Claims Auto Adjudication: Built for Speed and Accuracy 

Key Software’s solution eliminates bottlenecks with: 

• Blazing Processing: Handles 400 claims per minute with an exceptional degree of accuracy. 

• No Scaling Costs: A single license with standard pricing—no additional infrastructure needed. 

• AI-Driven Rule Creation: Harnesses AI to simplify and accelerate rule generation. 

• 24/7 Operation: Enables continuous claims processing with no downtime or scheduling limitations. 

The Bottom Line 

KS Claims Auto Adjudication delivers speed, accuracy, and scalability for today’s healthcare needs. 

✅ Ready to modernize your claims processing? 

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